Provider Demographics
NPI:1942814983
Name:QUAIL RIDGE SENIOR DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:QUAIL RIDGE SENIOR DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-705-9397
Mailing Address - Street 1:12401 TRAIL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1701
Mailing Address - Country:US
Mailing Address - Phone:405-755-5775
Mailing Address - Fax:
Practice Address - Street 1:12401 TRAIL OAKS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1701
Practice Address - Country:US
Practice Address - Phone:405-755-5775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE