MEDICARE: BAYSIDE BEHAVIORAL HEALTH IN 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1962240689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSIDE BEHAVIORAL HEALTH IN LLC

Provider Business Mailing Address
First Line	:	5929 LAKESIDE BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1996
Country	:	US
Telephone Number	:	317-520-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5929 LAKESIDE BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1996
Country	:	US
Telephone Number	:	317-520-8300
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID BRAUN
Credential	:
Telephone Number	:	347-263-3607

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	04/24/2026

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