Provider Demographics
NPI:1952394843
Name:BAYCARE HOME CARE INC.
Entity Type:Organization
Organization Name:BAYCARE HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. HOME CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:DENTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:727-934-6461
Mailing Address - Street 1:8452 118TH AVE N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-4821
Mailing Address - Country:US
Mailing Address - Phone:727-394-6461
Mailing Address - Fax:727-394-6550
Practice Address - Street 1:7014 A C SKINNER PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6959
Practice Address - Country:US
Practice Address - Phone:904-296-0605
Practice Address - Fax:904-332-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA21596096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107492Medicare ID - Type UnspecifiedPROVIDER NUMBER