Basic Information
Provider Information | |||||||||
NPI: | 1770514226 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BAYADA HOME HEALTH CARE, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 101 EXECUTIVE DR | ||||||||
Address2: | SUITE 4 | ||||||||
City: | MOORESTOWN | ||||||||
State: | NJ | ||||||||
PostalCode: | 080574236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8567784400 | ||||||||
FaxNumber: | 8567784103 | ||||||||
Practice Location | |||||||||
Address1: | 212 LE PHILLIP CT | ||||||||
Address2: | SUITE 202 | ||||||||
City: | CONCORD | ||||||||
State: | NC | ||||||||
PostalCode: | 280252984 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7047955000 | ||||||||
FaxNumber: | 7047955025 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/05/2006 | ||||||||
LastUpdateDate: | 02/10/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FLANNERY | ||||||||
AuthorizedOfficialFirstName: | STEPHEN | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING & COLLECTIONS | ||||||||
AuthorizedOfficialTelephone: | 8567931703 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | BAYADA HOME HEALTH CARE, INC. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | HC3467 | NC | N |   | Agencies | In Home Supportive Care |   | 251J00000X | HC3467 | NC | N |   | Agencies | Nursing Care |   | 251E00000X | HC3467 | NC | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 115652 | 01 | NC | CAREMARK, INC | OTHER | 007AY | 01 | NC | BC/BS OF NORTH CAROLINA | OTHER | 228865 | 01 | NC | ALLIANCE | OTHER | 228865 | 01 | NC | MAMSI | OTHER | 7107130 | 01 | NC | AETNA INSURANCE | OTHER | 6601545 | 05 | NC |   | MEDICAID | 7100591 | 05 | NC |   | MEDICAID | 2527159 | 01 | NC | AETNA/US HEALTHCARE | OTHER | 0076M | 01 | NC | BC/BS OF NORTH CAROLINA | OTHER | 1594 | 01 | NC | PIEDMONT | OTHER | 3408428 | 05 | NC |   | MEDICAID |