Basic Information
| Provider Information | |||||||||
| NPI: | 1538360011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYSHORE HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1609 TROUSDALE DR | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495401249 | ||||||||
| FaxNumber: | 9495403007 | ||||||||
| Practice Location | |||||||||
| Address1: | 1609 TROUSDALE DR | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940104520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495401249 | ||||||||
| FaxNumber: | 9495403007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BURNAM | ||||||||
| AuthorizedOfficialFirstName: | SOON | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 9495401249 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.