Healthcare Provider Details

I. General information

NPI: 1063734242
Provider Name (Legal Business Name): BAY ROC HEALTH CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W CATES ST
BRIDGEPORT TX
76426-2709
US

IV. Provider business mailing address

102 W CATES ST
BRIDGEPORT TX
76426-2709
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-5181
  • Fax: 940-683-5183
Mailing address:
  • Phone: 940-683-5181
  • Fax: 940-683-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE ANN CAVINESS
Title or Position: MANAGING MEMBER
Credential:
Phone: 940-683-5181