Healthcare Provider Details

I. General information

NPI: 1376164855
Provider Name (Legal Business Name): BAYWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HENDERSON AVE
STATEN ISLAND NY
10301-2108
US

IV. Provider business mailing address

110 HENDERSON AVE
STATEN ISLAND NY
10301-2108
US

V. Phone/Fax

Practice location:
  • Phone: 718-727-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHIA ROSENBAUM
Title or Position: MANAGER
Credential:
Phone: 718-727-8100