Provider Demographics
NPI:1801014147
Name:SOUTH BEND ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:SOUTH BEND ASSISTED LIVING LLC
Other - Org Name:DBA WOOD RIDGE ASSISTED LIVING COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HOESE
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:574-271-1151
Mailing Address - Street 1:17650 GENERATIONS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1536
Mailing Address - Country:US
Mailing Address - Phone:574-271-1151
Mailing Address - Fax:571-271-2812
Practice Address - Street 1:17650 GENERATIONS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1536
Practice Address - Country:US
Practice Address - Phone:574-271-1151
Practice Address - Fax:571-271-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility