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General NPI Number Information
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NPI Number | 1013455096
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Entity Type | Organization
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Legal Business Name | THE RANCH ALF, INC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 4919 LORRAINE RD
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City | BRADENTON
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State | FL
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Zip | 34211-9269
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Country | US
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Telephone | 941-504-9412
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Fax | 941-761-5200
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Provider Business Mailing Address
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Address Line | 4919 LORRAINE RD
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City | BRADENTON
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State | FL
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Zip | 34211-9269
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Country | US
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Telephone | 941-504-9412
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Fax | 941-761-5200
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Authorized Official
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Title or Position | OWNER / OPERATOR
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Name | MRS. MELISSA ANN BONGART
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Credential |
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Telephone | 941-504-9412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | AL12936
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | AL12936
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL12936
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License Number State | FL
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