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General NPI Number Information
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NPI Number | 1649255761
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Entity Type | Organization
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Legal Business Name | EAST RIDGE RETIREMENT VILLAGE, INC.
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 19225 SW 87TH AVE
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City | CUTLER BAY
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State | FL
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Zip | 33157-8984
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Country | US
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Telephone | 305-238-2623
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Fax | 305-256-3516
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Provider Business Mailing Address
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Address Line | 19225 SW 87TH AVE
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City | CUTLER BAY
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State | FL
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Zip | 33157-8984
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Country | US
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Telephone | 305-238-2623
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Fax | 305-256-3516
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Authorized Official
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Title or Position | SECRETARY OF BOARD OF DIRECTORS
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Name | MS. CAROLYN S. GARWOOD
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Credential |
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Telephone | 305-238-9617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL6091
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1136096
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License Number State | FL
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