Basic Information
| Provider Information | |||||||||
| NPI: | 1760423883 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAYADA HOME HEALTH CARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAYADA PEDIATRICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 2133 ARCH ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191031350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674432150 | ||||||||
| FaxNumber: | 2155642671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FLANNERY | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING & COLLECTIONS | ||||||||
| AuthorizedOfficialTelephone: | 8567784400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAYADA HOME HEALTH CARE, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 759805 | PA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1000020440170 | 05 | PA | MEDICAID |