Provider Demographics
NPI:1811101363
Name:BAY VILLAGE OF SARASOTA INC.
Entity type:Organization
Organization Name:BAY VILLAGE OF SARASOTA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-966-5611
Mailing Address - Street 1:8400 VAMO RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-7807
Mailing Address - Country:US
Mailing Address - Phone:941-966-5611
Mailing Address - Fax:941-966-4040
Practice Address - Street 1:8400 VAMO RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231
Practice Address - Country:US
Practice Address - Phone:941-966-5611
Practice Address - Fax:941-966-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20170096251E00000X
FLAL9166310400000X
FLSNF10400961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0002877700Medicaid