Provider Demographics
NPI:1164858262
Name:HIDDEN RANCHES ASSISTED LIVING, INC
Entity Type:Organization
Organization Name:HIDDEN RANCHES ASSISTED LIVING, INC
Other - Org Name:HIDDEN RANCHES ASSITED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KANETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-624-4901
Mailing Address - Street 1:1864 NW 175TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4840
Mailing Address - Country:US
Mailing Address - Phone:305-624-4901
Mailing Address - Fax:
Practice Address - Street 1:1864 NW 175TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4840
Practice Address - Country:US
Practice Address - Phone:305-624-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8744310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility