Provider Demographics
NPI:1750541231
Name:PARKE RIDGE ASSISTED LIVING ASSOC.
Entity type:Organization
Organization Name:PARKE RIDGE ASSISTED LIVING ASSOC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-708-2200
Mailing Address - Street 1:8420 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2064
Mailing Address - Country:US
Mailing Address - Phone:215-708-2200
Mailing Address - Fax:215-708-8711
Practice Address - Street 1:8420 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2064
Practice Address - Country:US
Practice Address - Phone:215-708-2200
Practice Address - Fax:215-708-8711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKE RIDGE ASSISTED LIVING ASSOC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-10
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA107870310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility