Provider Demographics
NPI:1548317837
Name:PARK RIDGE NURSING HOME, INC.
Entity type:Organization
Organization Name:PARK RIDGE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-ADMINISTRATION, NHA
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-723-7201
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7205
Mailing Address - Fax:585-723-7118
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7205
Practice Address - Fax:585-723-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314681Medicaid
NYNH771OtherPREFERRED CARE
NY15005993OtherBLUE CHOICE
NY25OtherBLUE CROSS
NY15005993OtherBLUE CHOICE
NY335369Medicare Oscar/Certification