Basic Information
| Provider Information | |||||||||
| NPI: | 1063743078 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYADA HOME HEALTH CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 EXECUTIVE DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | MOORESTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080574236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567784400 | ||||||||
| FaxNumber: | 8567784103 | ||||||||
| Practice Location | |||||||||
| Address1: | 1775 W SAINT MARYS RD | ||||||||
| Address2: | SUITE 214 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205319600 | ||||||||
| FaxNumber: | 5205319666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2010 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | FLANNERY | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR BILLING AND COLLECTIONS | ||||||||
| AuthorizedOfficialTelephone: | 8567784400 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAYADA HOME HEALTH CARE, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HHA-1562 | AZ | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 467672 | 05 | AZ | MEDICAID |