Healthcare Provider Details

I. General information

NPI: 1942431010
Provider Name (Legal Business Name): GENESIS HEALTH CARE/BAYVIEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S BAY ST
EUTIS FL
32726
US

IV. Provider business mailing address

301 SOUTH BAY
EUTIS FL
32726
US

V. Phone/Fax

Practice location:
  • Phone: 352-357-8105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA10894
License Number StateFL

VIII. Authorized Official

Name: MRS. TINA M LARGE
Title or Position: OCCUPATIONAL THERAPIST ASSISTANT
Credential:
Phone: 386-624-7467