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General NPI Number Information
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NPI Number | 1821625302
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Entity Type | Organization
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Legal Business Name | BA-R3L LLC
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 7771 43RD ST N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3621
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Country | US
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Telephone | 727-954-7085
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Fax | 727-201-4706
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Provider Business Mailing Address
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Address Line | 7771 43RD ST N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-3621
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Country | US
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Telephone | 727-954-7085
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Fax | 727-201-4706
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Authorized Official
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Title or Position | OWNER
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Name | MR. RUDY BAUTISTA
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Credential |
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Telephone | 727-647-2209
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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 |
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License Number State |
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