Organization
NIC 4 BAYSIDE TERRACE LEASING LLC
Active
Other names
Bayside Terrace
Organization subpart
No
Provider details
NPI number
Authorized official
JANE RYU (PRESIDENT/CEO/CFO)
(212) 479-5270
Entity
Organization
Contact information
Practice address
9381 U.S. 19, PINELLAS PARK, FL 33782
(727) 576-1234
(727) 570-2257
Mailing address
PO BOX 1700, NIC 4 BAYSIDE TERRACE LEASING LLC, C/O HOLIDAY RETIREMENT, LAKE OSWEGO, OR 97035
(971) 245-8020
(503) 431-2296
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
6139
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004295900
MEDICAID AL WAIVER
FL
Enumeration date
04/24/2013
Last updated
12/08/2016
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