=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497090997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAGSIYAO CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2012
-----------------------------------------------------
Last Update Date | 12/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3615 MCNEIL RD
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-6818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-883-0643
-----------------------------------------------------
Fax | 407-292-6180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3615 MCNEIL RD
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-6818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-883-0643
-----------------------------------------------------
Fax | 407-292-6180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATO
-----------------------------------------------------
Name | MRS. CORAZON BAGSIYAO
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 407-883-0643
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL9202
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------