Provider Demographics
NPI:1912226838
Name:BAYSHORE GERIATRIC SOLUTIONS, INC.
Entity Type:Organization
Organization Name:BAYSHORE GERIATRIC SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:GRIFFIN
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-246-4120
Mailing Address - Street 1:9270 BAY PLAZA BLVD STE 604
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4494
Mailing Address - Country:US
Mailing Address - Phone:813-246-4120
Mailing Address - Fax:813-246-4194
Practice Address - Street 1:9270 BAY PLAZA BLVD STE 604
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4494
Practice Address - Country:US
Practice Address - Phone:813-246-4120
Practice Address - Fax:813-246-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty