Provider Demographics
NPI:1992554349
Name:BLUE RIBBON CARE ASSISTED LIVING FACILITY III, LLC
Entity type:Organization
Organization Name:BLUE RIBBON CARE ASSISTED LIVING FACILITY III, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENNAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-510-0286
Mailing Address - Street 1:8335 NW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1629
Mailing Address - Country:US
Mailing Address - Phone:786-510-0286
Mailing Address - Fax:
Practice Address - Street 1:8335 NW 80TH ST
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1629
Practice Address - Country:US
Practice Address - Phone:786-510-0286
Practice Address - Fax:561-354-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility