MEDICARE: BAY SHORES NURSING CENTER, 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
1	332BN1400X	Nursing Facility Supplies (DME)	094050	MI
2	314000000X	Skilled Nursing Facility	094050	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09644	OTHER	MI	BCBSM
2	0Z91079	OTHER	MI	BCBS DME P&0
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891845210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY SHORES NURSING CENTER, LLC

Provider Business Mailing Address
First Line	:	10503 CITATION DR STE 100
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-6551
Country	:	US
Telephone Number	:	810-534-0150
Fax Number	:	810-534-0208

Provider Business Practice Location Address
First Line	:	3254 E MIDLAND RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2835
Country	:	US
Telephone Number	:	989-686-3770
Fax Number	:	989-686-3414

Authorized Official
Title or Position	:	CFO
Name	:	TODD SANGSTER
Credential	:
Telephone Number	:	810-534-0150

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	05/05/2022

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