Healthcare Provider Details

I. General information

NPI: 1114679685
Provider Name (Legal Business Name): BAYONET OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8132 HUDSON AVE
HUDSON FL
34667-8571
US

IV. Provider business mailing address

8132 HUDSON AVE
HUDSON FL
34667-8571
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-3100
  • Fax: 727-862-8913
Mailing address:
  • Phone: 727-863-3100
  • Fax: 727-862-8913

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: MATHEW VARGHESE
Title or Position: MEMBER
Credential:
Phone: 917-817-3530