Healthcare Provider Details

I. General information

NPI: 1013455096
Provider Name (Legal Business Name): THE RANCH ALF, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 LORRAINE RD
BRADENTON FL
34211-9269
US

IV. Provider business mailing address

4919 LORRAINE RD
BRADENTON FL
34211-9269
US

V. Phone/Fax

Practice location:
  • Phone: 941-504-9412
  • Fax: 941-761-5200
Mailing address:
  • Phone: 941-504-9412
  • Fax: 941-761-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL12936
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL12936
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAL12936
License Number StateFL

VIII. Authorized Official

Name: MRS. MELISSA ANN BONGART
Title or Position: OWNER / OPERATOR
Credential:
Phone: 941-504-9412