Provider Demographics
NPI:1629458351
Name:GAHC3 BENNINGTON NE ALF TRS SUB, LLC
Entity Type:Organization
Organization Name:GAHC3 BENNINGTON NE ALF TRS SUB, LLC
Other - Org Name:RIDGEWOOD ACTIVE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-270-9200
Mailing Address - Street 1:12301 N 149TH CIR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-5775
Mailing Address - Country:US
Mailing Address - Phone:402-884-7644
Mailing Address - Fax:402-884-8631
Practice Address - Street 1:12301 N 149TH CIR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-5775
Practice Address - Country:US
Practice Address - Phone:402-884-7644
Practice Address - Fax:402-884-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025948400Medicaid