Provider Demographics
NPI:1063441996
Name:BAY GROUP HEALTH CARE LLC
Entity type:Organization
Organization Name:BAY GROUP HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-629-5492
Mailing Address - Street 1:6160 N CICERO AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4312
Mailing Address - Country:US
Mailing Address - Phone:773-282-9610
Mailing Address - Fax:773-282-9615
Practice Address - Street 1:6160 N CICERO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4312
Practice Address - Country:US
Practice Address - Phone:773-282-9610
Practice Address - Fax:773-282-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010557251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147914Medicare Oscar/Certification