Healthcare Provider Details

I. General information

NPI: 1760479166
Provider Name (Legal Business Name): BAYSIDE HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 WALL BLVD
GRETNA LA
70056-7755
US

IV. Provider business mailing address

200 W UNIVERSITY AVE
HAMMOND LA
70401-1319
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-1515
  • Fax: 504-391-7426
Mailing address:
  • Phone: 985-429-8800
  • Fax: 985-542-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number889
License Number StateLA

VIII. Authorized Official

Name: MR. DANIEL J LABORDE
Title or Position: COO
Credential:
Phone: 985-429-8800