=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871297093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY AGING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2023
-----------------------------------------------------
Last Update Date | 03/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5306 OLD VIRGINIA STREET
-----------------------------------------------------
City | URBANNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23175-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-758-2386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 610
-----------------------------------------------------
City | URBANNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23175-0610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-758-2386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | KATHY ELLEN VESLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-758-2386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------