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Organization

BLUE RIDGE BY THE LAKE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. LEVI RUDD (CEO)
(786) 358-5200
Entity
Organization

Contact information

Practice address
1100 66TH ST N, ST PETERSBURG, FL 33710-6224
(727) 345-9331
Mailing address
2700 N 29TH AVE, SUITE 308, HOLLYWOOD, FL 33020-1520
(786) 358-5200

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary

Other

Enumeration date
01/07/2016
Last updated
01/07/2016
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