Provider Demographics
NPI:1508270380
Name:HEATHERIDGE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:HEATHERIDGE HEALTH CARE, LLC
Other - Org Name:HEATHERIDGE ASSISTED LIVING & RESIDENTIAL CARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-631-3000
Mailing Address - Street 1:2130 S 85TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-3066
Mailing Address - Country:US
Mailing Address - Phone:918-622-9191
Mailing Address - Fax:918-622-9205
Practice Address - Street 1:2130 S 85TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-3066
Practice Address - Country:US
Practice Address - Phone:918-622-9191
Practice Address - Fax:918-622-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility