Pride Tribe Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PRIDE TRIBE INC.

Practice address

716 NW 1St Ave
Boynton Beach, FL 33426-4304

Phone

(561) 541-3700

NPI assigned

Aug 3, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gaylord Allan Hendricks, ADMINISTRATORNPI 1700662376

Title

Ceo

Phone

(561) 541-3700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Connie House ALF Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gaylord Allan Hendricks

  • Assisted Living Facility
  • Boynton Beach, FL
  • NPI 1700662376
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1043040249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 NW 1ST AVE",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334264304",
            "telephone_number": "561-541-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 NW 1ST AVE",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334264304",
            "telephone_number": "561-541-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIDE TRIBE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "GAYLORD",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-541-3700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700662376",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connie House ALF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeffrey A Press, M.D.
• Gregory Stephen Presti
• Prestigious Assited Living LLC Dba Parkside Inn
• Prevalus Enterprise LLC
• Wendy Lynn Price
• Maria Priede
• Primary Care Medical Associates, Inc.
• Primary Care Solutions Medical Centers LLC
• Primezen Solutions
• Primus Health Network, LLC

• Assisted Living Facility in Boynton Beach, FL
• Providers in Boynton Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.