Healthcare Provider Details

I. General information

NPI: 1366807562
Provider Name (Legal Business Name): BAYSHORE MEMORY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 CREEKSIDE BLVD E
NAPLES FL
34109-0579
US

IV. Provider business mailing address

1260 CREEKSIDE BLVD E
NAPLES FL
34109-0579
US

V. Phone/Fax

Practice location:
  • Phone: 239-213-9370
  • Fax: 239-598-5409
Mailing address:
  • Phone: 239-213-9370
  • Fax: 239-598-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberAL 12760
License Number StateFL

VIII. Authorized Official

Name: MS. CHRISTINE G. VARNER
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 239-213-9370