1467585422 NPI number — RIDGECREST RITIREMENT COMMUNITY

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 1467585422 NPI number — RIDGECREST RITIREMENT COMMUNITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGECREST RITIREMENT COMMUNITY
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:
1467585422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RIDGECREST RETIREMENT COMMUNITY
Provider Second Line Business Mailing Address:
1000 RIDGECREST LANE
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-786-9100
Provider Business Mailing Address Fax Number:
336-786-2899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RIDGECREST RETIREMENT, LLC
Provider Second Line Business Practice Location Address:
1000 RIDGECREST LN.
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-786-9100
Provider Business Practice Location Address Fax Number:
336-786-2899
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VERNON
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
BONDURANT
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
336-786-9100

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  HAL086010 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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