Provider Demographics
NPI:1003119462
Name:LEDGEWOOD BAY RETIREMENT LIVING LLC
Entity Type:Organization
Organization Name:LEDGEWOOD BAY RETIREMENT LIVING LLC
Other - Org Name:LEDGEWOOD BAY ASSISTED LIVING AND MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLATCHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:416-487-2020
Mailing Address - Street 1:1818 LIBRARY ST
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-6242
Mailing Address - Country:US
Mailing Address - Phone:416-487-2020
Mailing Address - Fax:
Practice Address - Street 1:43 LEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-6736
Practice Address - Country:US
Practice Address - Phone:603-672-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03650310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility