Provider Demographics
NPI:1225532419
Name:BFG KENNEWICK MASTER TENANT, LLC
Entity Type:Organization
Organization Name:BFG KENNEWICK MASTER TENANT, LLC
Other - Org Name:FIELDSTONE GRANDRIDGE INDEPENDENT AND ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INDIRECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-644-6444
Mailing Address - Street 1:228 N PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3886
Mailing Address - Country:US
Mailing Address - Phone:407-644-6444
Mailing Address - Fax:
Practice Address - Street 1:7255 W GRANDRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7742
Practice Address - Country:US
Practice Address - Phone:509-491-3946
Practice Address - Fax:509-491-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility