1306293170 NPI number — RIDGEWOOD HEALTHCARE LLC

Table of content: (NPI 1306293170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306293170 NPI number — RIDGEWOOD HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGEWOOD HEALTHCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIDGEWOOD LIVING AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306293170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ROUTE 70 STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-7406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-659-1353
Provider Business Mailing Address Fax Number:
866-306-0259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1624 HIGHLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27889-8761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-946-9570
Provider Business Practice Location Address Fax Number:
252-946-3715
Provider Enumeration Date:
05/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
STERN
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
732-659-1353

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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