| Bayside Recoery And Wellness Center Llc | |
|
1501 Robert J Conlan Blvd Ne Ste 7 Palm Bay FL 32905-3559 | |
| (321) 372-6897 | |
| (321) 372-6896 |
| Full Name | Bayside Recoery And Wellness Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1501 Robert J Conlan Blvd Ne Ste 7, Palm Bay, Florida |
| Authorized Official Name and Position | Morgan O'shaughnessy (CEO/CLINCIAL DIRECTOR) |
| Authorized Official Contact | 3213726897 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bayside Recoery And Wellness Center Llc 1501 Robert J Conlan Blvd Ne Ste 7 Palm Bay FL 32905-3559 Ph: (321) 372-6897 | Bayside Recoery And Wellness Center Llc 1501 Robert J Conlan Blvd Ne Ste 7 Palm Bay FL 32905-3559 Ph: (321) 372-6897 |
| NPI Number | 1134775976 |
|---|---|
| Provider Enumeration Date | 08/16/2019 |
| Last Update Date | 12/13/2021 |
| Certification Date | 12/13/2021 |
| Medicare PECOS PAC ID | 9032507272 |
|---|---|
| Medicare Enrollment ID | O20211021000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134775976 | NPI | - | NPPES |
| Provider Name | Bethann Mahoney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104990217 PECOS PAC ID: 2264424936 Enrollment ID: I20131218000793 |
| Provider Name | Agustin Gracia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295469054 PECOS PAC ID: 0345624110 Enrollment ID: I20220826002895 |
| Provider Name | Kerstin D Welch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174283097 PECOS PAC ID: 7113391939 Enrollment ID: I20230317002108 |
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