1407316896 NPI number — RIDGE CARE MANAGEMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407316896 NPI number — RIDGE CARE MANAGEMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGE CARE MANAGEMENT, INC.
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:
Provider Other Organization Name Type Code:
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:
1407316896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
853 OLD WINSTON RD STE 118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KERNERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27284-8781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-993-7555
Provider Business Mailing Address Fax Number:
336-993-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 VILLAGE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST JEFFERSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28694-6015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-846-1008
Provider Business Practice Location Address Fax Number:
336-846-1147
Provider Enumeration Date:
03/21/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEAGLE
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
336-993-7555

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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