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General NPI Number Information
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NPI Number | 1104279777
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Entity Type | Organization
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Legal Business Name | BAYADA
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 18001 N. 79TH AVE BLDG A, SUITE 3
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 623-979-5266
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Fax |
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Provider Business Mailing Address
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Address Line | 11709 WEST DALEY LANE
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City | SUN CITY
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State | AZ
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Zip | 85373
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Country | US
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Telephone | 623-777-1921
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK BAIDA
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Credential |
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Telephone | 623-979-5266
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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 | 11770
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License Number State | AZ
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