Healthcare Provider Details

I. General information

NPI: 1811233570
Provider Name (Legal Business Name): BAYA NURSING AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 SE ERMINE AVE
LAKE CITY FL
32025-6126
US

IV. Provider business mailing address

587 SE ERMINE AVE
LAKE CITY FL
32025-6126
US

V. Phone/Fax

Practice location:
  • Phone: 386-752-7800
  • Fax: 386-752-7337
Mailing address:
  • Phone: 386-752-7800
  • Fax: 386-752-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF12700961
License Number StateFL

VIII. Authorized Official

Name: CRAIG E ROBINSON
Title or Position: MANAGER
Credential:
Phone: 407-215-9800