Provider Demographics
NPI:1427154897
Name:BAYWIND VILLAGE INC
Entity type:Organization
Organization Name:BAYWIND VILLAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BARCELO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-332-9588
Mailing Address - Street 1:411 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2615
Mailing Address - Country:US
Mailing Address - Phone:281-332-9588
Mailing Address - Fax:281-316-2715
Practice Address - Street 1:411 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2615
Practice Address - Country:US
Practice Address - Phone:281-332-9588
Practice Address - Fax:281-316-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117573314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000517503Medicaid
TX021911501Medicaid
TX000517503Medicaid