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General NPI Number Information
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NPI Number | 1780011536
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Entity Type | Organization
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Legal Business Name | BAYSHORE HOME HEALTHCARE, INC .
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 55 E MAIN ST
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City | BAY SHORE
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State | NY
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Zip | 11706-8366
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Country | US
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Telephone | 631-647-9020
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Fax | 631-647-9021
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Provider Business Mailing Address
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Address Line | 55 E MAIN ST
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City | BAY SHORE
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State | NY
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Zip | 11706-8366
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Country | US
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Telephone | 631-647-9020
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Fax | 631-647-9021
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. PATRICIA HARLEY
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Credential | PH.D.
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Telephone | 631-647-9020
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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 | 2473L001
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License Number State | NY
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