Provider Demographics
NPI:1013455096
Name:THE RANCH ALF, INC
Entity Type:Organization
Organization Name:THE RANCH ALF, INC
Other - Org Name:THE RANCH ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BONGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-504-9412
Mailing Address - Street 1:4919 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9269
Mailing Address - Country:US
Mailing Address - Phone:941-504-9412
Mailing Address - Fax:941-761-5200
Practice Address - Street 1:4919 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9269
Practice Address - Country:US
Practice Address - Phone:941-504-9412
Practice Address - Fax:941-761-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12936310400000X, 3104A0625X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12936OtherAHCA LICENSE NUMBER
FL019988800Medicaid