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NPI Code Detail

MEDICARE: BAYSHORE DULUTH MANAGEMENT, LLC

MEDICARE: BAYSHORE DULUTH MANAGEMENT, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1821433426
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAYSHORE DULUTH MANAGEMENT, LLC
Provider Business Mailing Address
First Line : 7150 PARSONS BLVD STE 1001
Second Line : C/O PARAGON HEALTHCARE
City : FLUSHING
State : NY
Zip : 11365-4131
Country : US
Telephone Number : 718-408-8953
Fax Number :
Provider Business Practice Location Address
First Line : 1601 SAINT LOUIS AVE
Second Line :
City : DULUTH
State : MN
Zip : 55802-2442
Country : US
Telephone Number : 218-727-8651
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : ELIEZER DEITSCH
Credential :
Telephone Number : 516-250-1260
Provider Enumeration Date : 05/08/2013
Last Update Date : 05/08/2013

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Directions to “BAYSHORE DULUTH MANAGEMENT, LLC ” Practice Location

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