Provider Demographics
NPI:1467436907
Name:STONERIDGE SENIOR CARE LLC
Entity Type:Organization
Organization Name:STONERIDGE SENIOR CARE LLC
Other - Org Name:AVALON HEALTH CARE CENTER AT STONERIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEINBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-999-2400
Mailing Address - Street 1:186 JERRY BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-4004
Mailing Address - Country:US
Mailing Address - Phone:860-536-9700
Mailing Address - Fax:860-536-9300
Practice Address - Street 1:186 JERRY BROWN RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355
Practice Address - Country:US
Practice Address - Phone:860-572-5613
Practice Address - Fax:860-245-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2305314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
075437Medicare Oscar/Certification