Nic 4 Bayside Terrace Leasing LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

6139 Issued in FL

Legal business name

NIC 4 BAYSIDE TERRACE LEASING LLC

Practice address

9381 U.S. 19
Pinellas Park, FL 33782

Phone

(727) 576-1234

Fax

(727) 570-2257

NPI assigned

Apr 24, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jane Ryu

Title

President/Ceo/Cfo

Phone

(212) 479-5270

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bayside Terrace Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481155200000",
    "number": "1528402229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1700, NIC 4 BAYSIDE TERRACE LEASING LLC",
            "address_2": "C/O HOLIDAY RETIREMENT",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "971-245-8020",
            "fax_number": "503-431-2296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9381 U.S. 19",
            "city": "PINELLAS PARK",
            "state": "FL",
            "postal_code": "33782",
            "telephone_number": "727-576-1234",
            "fax_number": "727-570-2257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC 4 BAYSIDE TERRACE LEASING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-24",
        "last_updated": "2016-12-08",
        "status": "A",
        "authorized_official_last_name": "RYU",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "212-479-5270"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "6139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID AL WAIVER",
            "identifier": "004295900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayside Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Pinellas Park, FL
• Providers in Pinellas Park, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.