Provider Demographics
NPI:1194042192
Name:EAST RIDGE RETIREMENT VILLAGE, INC.
Entity Type:Organization
Organization Name:EAST RIDGE RETIREMENT VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-669-6000
Mailing Address - Street 1:19301 SW 87TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8999
Mailing Address - Country:US
Mailing Address - Phone:305-238-2623
Mailing Address - Fax:305-256-3516
Practice Address - Street 1:19301 SW 87TH AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-8999
Practice Address - Country:US
Practice Address - Phone:305-238-2623
Practice Address - Fax:305-256-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20315096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health