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General NPI Number Information
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NPI Number | 1790695062
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Entity Type | Organization
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Legal Business Name | HOLDEN RIDGE COMMUNITY LIVING S CORP
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 1244 TYLER LAKE CIR
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City | ORLANDO
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State | FL
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Zip | 32839-1995
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Country | US
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Telephone | 954-552-4366
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Fax | 877-518-7525
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Provider Business Mailing Address
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Address Line | 1244 TYLER LAKE CIR
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City | ORLANDO
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State | FL
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Zip | 32839-1995
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Country | US
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Telephone | 954-552-4366
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Fax | 877-518-7525
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TESFAMARIAM G BAHTA
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Credential | PHARMD
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Telephone | 954-552-4366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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