Provider Demographics
NPI:1932570165
Name:PRY INC
Entity Type:Organization
Organization Name:PRY INC
Other - Org Name:GOOD SAMARITAN RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-435-5548
Mailing Address - Street 1:507 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-2703
Mailing Address - Country:US
Mailing Address - Phone:352-528-2722
Mailing Address - Fax:407-528-3003
Practice Address - Street 1:507 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:FL
Practice Address - Zip Code:32696-2703
Practice Address - Country:US
Practice Address - Phone:352-528-2722
Practice Address - Fax:407-528-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness