Provider Demographics
NPI:1215347745
Name:SWANKRIDGE, INC.
Entity type:Organization
Organization Name:SWANKRIDGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLYANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-248-9662
Mailing Address - Street 1:120 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3213
Mailing Address - Country:US
Mailing Address - Phone:305-248-9662
Mailing Address - Fax:305-248-3451
Practice Address - Street 1:120 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3213
Practice Address - Country:US
Practice Address - Phone:305-248-9662
Practice Address - Fax:305-248-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5057310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility