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General NPI Number Information
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NPI Number | 1679388789
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Entity Type | Organization
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Legal Business Name | BAYSIDE HOUSING, LLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 611 LAKESIDE DR
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City | SALISBURY
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State | MD
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Zip | 21801-4114
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Country | US
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Telephone | 301-906-0135
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Fax |
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Provider Business Mailing Address
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Address Line | 8908 BRANCHVIEW DR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-4809
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Country | US
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Telephone | 301-686-1544
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Fax | 301-686-1544
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KEVIN L HENRY
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Credential |
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Telephone | 301-906-0135
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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 |
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License Number State |
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