Healthcare Provider Details

I. General information

NPI: 1427062488
Provider Name (Legal Business Name): UCP BAYVILLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BAYVILLE AVE
BAYVILLE NY
11709-1629
US

IV. Provider business mailing address

85 BAYVILLE AVE
BAYVILLE NY
11709-1629
US

V. Phone/Fax

Practice location:
  • Phone: 516-628-3500
  • Fax: 516-628-1121
Mailing address:
  • Phone: 516-628-3500
  • Fax: 516-628-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number8077440
License Number StateNY

VIII. Authorized Official

Name: MR. PAUL LOWRY
Title or Position: ADMINISTRATOR
Credential:
Phone: 516-628-3500