Provider Demographics
NPI:1790167682
Name:BLUE RIBBON CARE ASSISTED LIVING FACILTY, LLC
Entity Type:Organization
Organization Name:BLUE RIBBON CARE ASSISTED LIVING FACILTY, LLC
Other - Org Name:BLUE RIBBON CARE ASSISTED LIVING FACILITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENNAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:786-510-0286
Mailing Address - Street 1:125 AINSWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2015
Mailing Address - Country:US
Mailing Address - Phone:786-510-0286
Mailing Address - Fax:561-354-6031
Practice Address - Street 1:125 AINSWORTH CIR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2015
Practice Address - Country:US
Practice Address - Phone:786-510-0286
Practice Address - Fax:561-354-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility