=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306108253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYCARE BEHAVIORAL HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2012
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14527 7TH ST
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33523-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-521-1474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2995 DREW ST FL 2
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33759-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-315-6974
-----------------------------------------------------
Fax | 813-635-2613
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. LYNDA GORKEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-281-9390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------