# BAY AREA DIRECT CLIENT CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356835862
- **Authorized official:** DESHAE MARTIN NURSE PRACTITIONER (ADMINISTRATIVE DIRECTOR)
- **Authorized official phone:** (813) 585-7708

## Contact information

- **Practice address:** 110 LITHIA PINECREST RD STE B, BRANDON, FL 33511-5300
- **Practice address phone:** (813) 679-5122
- **Mailing address:** 2105 ROANOKE SPRINGS DR, RUSKIN, FL 33570-6312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0001X | Clinical & Laboratory Immunology (Internal Medicine) Physician | — | NULL | Yes |
| 207RI0001X | Clinical & Laboratory Immunology (Internal Medicine) Physician | — | — | Yes |
| 251E00000X | Home Health Agency | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NULL | — |
| 373H00000X | Day Training/Habilitation Specialist | — | FL | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 06/18/2018
- **Last updated:** 06/11/2021