Provider Demographics
NPI:1487080321
Name:BAY RIDGE ASSISTED LIVING CENTER
Entity type:Organization
Organization Name:BAY RIDGE ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:REENDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-842-2425
Mailing Address - Street 1:3825 SCENIC RDG
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3900
Mailing Address - Country:US
Mailing Address - Phone:231-932-9757
Mailing Address - Fax:231-932-8376
Practice Address - Street 1:3825 SCENIC RDG
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3900
Practice Address - Country:US
Practice Address - Phone:231-932-9757
Practice Address - Fax:231-932-8376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH280027829310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility