Healthcare Provider Details

I. General information

NPI: 1033429311
Provider Name (Legal Business Name): BAYSIDE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 N GENRICH DR
SANFORD MI
48657-9569
US

IV. Provider business mailing address

3323 N. GENRICH DRIVE
SANFORD MI
48657-9569
US

V. Phone/Fax

Practice location:
  • Phone: 989-941-0555
  • Fax: 989-941-0670
Mailing address:
  • Phone: 989-941-0555
  • Fax: 989-941-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY M VOGEL
Title or Position: OWNER
Credential:
Phone: 989-941-0555