Healthcare Provider Details

I. General information

NPI: 1881256493
Provider Name (Legal Business Name): BAYSHORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 LAKEPARK DR
HOT SPRINGS AR
71901-9260
US

IV. Provider business mailing address

260 LAKEPARK DR
HOT SPRINGS AR
71901-9260
US

V. Phone/Fax

Practice location:
  • Phone: 501-262-1920
  • Fax:
Mailing address:
  • Phone: 501-262-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MATHIAS P DASAL
Title or Position: MANAGER OF A MANAGER MANAGED LLC
Credential:
Phone: 573-746-7100