Provider Demographics
NPI:1376692582
Name:HAMLIN TERRACE FOUNDATION
Entity Type:Organization
Organization Name:HAMLIN TERRACE FOUNDATION
Other - Org Name:RIDGE TERRACE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-582-6711
Mailing Address - Street 1:2180 HYPOLUXO RD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3922
Mailing Address - Country:US
Mailing Address - Phone:561-582-6711
Mailing Address - Fax:561-582-2675
Practice Address - Street 1:2180 HYPOLUXO RD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3922
Practice Address - Country:US
Practice Address - Phone:561-582-6711
Practice Address - Fax:561-582-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1474095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025958600Medicaid
FL105485Medicare Oscar/Certification