Provider Demographics
NPI:1689136301
Name:PARK RIDGE AL AMOP, LLC
Entity Type:Organization
Organization Name:PARK RIDGE AL AMOP, LLC
Other - Org Name:SPRING HILLS PARK RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-953-0546
Mailing Address - Street 1:150 CLOVE ROAD
Mailing Address - Street 2:FLOOR 7
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:201-953-0546
Mailing Address - Fax:
Practice Address - Street 1:124 NOYES DR
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1294
Practice Address - Country:US
Practice Address - Phone:201-782-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ512231Medicaid