Healthcare Provider Details

I. General information

NPI: 1497741565
Provider Name (Legal Business Name): BAY HOME MEDICAL & REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 COUNTY RD HQ
MARQUETTE MI
49855
US

IV. Provider business mailing address

707 PARSONS RD
TRAVERSE CITY MI
49686
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-1135
  • Fax: 906-225-5035
Mailing address:
  • Phone: 231-933-1200
  • Fax: 231-933-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. DUANE RICKEBERG
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 231-933-1200