Healthcare Provider Details

I. General information

NPI: 1013757624
Provider Name (Legal Business Name): BAHIA HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 GULF DR STE 207
NEW PORT RICHEY FL
34652-3909
US

IV. Provider business mailing address

8011 N HIMES AVE STE 1
TAMPA FL
33614-2700
US

V. Phone/Fax

Practice location:
  • Phone: 727-755-0202
  • Fax: 727-354-6648
Mailing address:
  • Phone: 727-755-0202
  • Fax: 727-354-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ORNIEL HERNANDEZ GONZALEZ
Title or Position: OWNER/DON
Credential:
Phone: 727-755-0202