Organization
NIC 4 BALMORAL LEASING LLC
Active
Other names
Balmoral Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
JANE RYU (PRESIDENT/CEO/CFO)
(212) 479-5270
Entity
Organization
Contact information
Practice address
93 BALMORAL DRIVE, LAKE PLACID, FL 33852
(863) 465-6584
(863) 465-6585
Mailing address
PO BOX 1700, NIC 4 BALMORAL LEASING LLC, C/O HOLIDAY RETIREMENT, LAKE OSWEGO, OR 97035
(971) 245-8020
(503) 431-2296
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11307
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003688600
MEDICAID AL WAIVER
FL
Enumeration date
04/24/2013
Last updated
11/30/2016
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