Provider Demographics
NPI:1205107034
Name:BAYVIEW WELLNESS CENTER & SPA LLC
Entity type:Organization
Organization Name:BAYVIEW WELLNESS CENTER & SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:315-591-7847
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:13064-0532
Mailing Address - Country:US
Mailing Address - Phone:315-591-7847
Mailing Address - Fax:
Practice Address - Street 1:498 MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:NY
Practice Address - Zip Code:13156-4251
Practice Address - Country:US
Practice Address - Phone:315-591-7847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024754225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty