Provider Demographics
NPI:1558933846
Name:EMBRY RIDGE SENIOR CARE LLC
Entity Type:Organization
Organization Name:EMBRY RIDGE SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-230-2675
Mailing Address - Street 1:5313 PADUA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-0404
Mailing Address - Country:US
Mailing Address - Phone:702-258-1669
Mailing Address - Fax:
Practice Address - Street 1:5313 PADUA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-0404
Practice Address - Country:US
Practice Address - Phone:702-258-1669
Practice Address - Fax:702-258-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home