Provider Demographics
NPI:1396229787
Name:BISHOP SUGARLAND RIDGE LESSEE LLC
Entity Type:Organization
Organization Name:BISHOP SUGARLAND RIDGE LESSEE LLC
Other - Org Name:ELMCROFT OF SUGARLAND RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-472-4067
Mailing Address - Street 1:5885 MEADOWS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8646
Mailing Address - Country:US
Mailing Address - Phone:971-254-1368
Mailing Address - Fax:
Practice Address - Street 1:1551 SUGARLAND DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5721
Practice Address - Country:US
Practice Address - Phone:307-674-5575
Practice Address - Fax:307-674-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYPENDINGMedicaid