Provider Demographics
NPI:1205377223
Name:PARK RIDGE LIVING CENTER
Entity Type:Organization
Organization Name:PARK RIDGE LIVING CENTER
Other - Org Name:PRNH NON-OCCUPANT ADC ST. BERNARDS
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. VP BH, HOME & COM, MLTC/PACE
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-368-3287
Mailing Address - Street 1:2260 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-5758
Mailing Address - Country:US
Mailing Address - Phone:585-254-7990
Mailing Address - Fax:585-254-8139
Practice Address - Street 1:2260 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-5758
Practice Address - Country:US
Practice Address - Phone:585-254-7990
Practice Address - Fax:585-254-8139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK RIDGE NURSING HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care