Provider Demographics
NPI:1366537763
Name:BAYBERRY HOME HEALTH, INC.
Entity type:Organization
Organization Name:BAYBERRY HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-855-5912
Mailing Address - Street 1:3236 REID DR STE D
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2525
Mailing Address - Country:US
Mailing Address - Phone:361-855-5912
Mailing Address - Fax:361-855-7326
Practice Address - Street 1:3236 REID DR STE D
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2525
Practice Address - Country:US
Practice Address - Phone:361-855-5912
Practice Address - Fax:361-855-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012775251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX678080Medicare ID - Type Unspecified