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General NPI Number Information
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NPI Number | 1063441996
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Entity Type | Organization
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Legal Business Name | BAY GROUP HEALTH CARE LLC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 6160 N CICERO AVE SUITE 104
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City | CHICAGO
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State | IL
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Zip | 60646-4312
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Country | US
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Telephone | 773-282-9610
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Fax | 773-282-9615
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Provider Business Mailing Address
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Address Line | 6160 N CICERO AVE SUITE 104
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City | CHICAGO
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State | IL
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Zip | 60646-4312
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Country | US
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Telephone | 773-282-9610
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Fax | 773-282-9615
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Authorized Official
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Title or Position | ALT. ADMINISTRATOR
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Name | MR. MAX AZAROV
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Credential |
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Telephone | 219-629-5492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010557
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License Number State | IL
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