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General NPI Number Information
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NPI Number | 1497170195
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Entity Type | Organization
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Legal Business Name | BAY OAKS HISTORIC RETIREMENT RESIDENCE
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 435 NE 34TH ST
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City | MIAMI
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State | FL
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Zip | 33137-4012
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Country | US
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Telephone | 305-573-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 435 NE 34TH ST
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City | MIAMI
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State | FL
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Zip | 33137-4012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KATHRYN KASSNER
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Credential |
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Telephone | 305-573-4337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL5168
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License Number State | FL
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