Healthcare Provider Details

I. General information

NPI: 1508864521
Provider Name (Legal Business Name): BAYCARE BEHAVIORAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7809 MASSACHUSETTS AVE
NEW PORT RICHEY FL
34653-3028
US

IV. Provider business mailing address

2995 DREW ST 2ND FLOOR
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-841-4200
  • Fax:
Mailing address:
  • Phone: 727-281-9065
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPH13085
License Number StateFL

VIII. Authorized Official

Name: MRS. LYNDA GORKEN
Title or Position: VICE-PRESIDENT
Credential:
Phone: 727-281-9390