Provider Demographics
NPI:1104436443
Name:BAYWOOD MEADOWS ASSISTED LIVING
Entity type:Organization
Organization Name:BAYWOOD MEADOWS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-341-7579
Mailing Address - Street 1:105 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4601
Mailing Address - Country:US
Mailing Address - Phone:386-275-1102
Mailing Address - Fax:386-275-1102
Practice Address - Street 1:105 BAYWOOD DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4601
Practice Address - Country:US
Practice Address - Phone:386-275-1102
Practice Address - Fax:386-275-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106770600Medicaid