MEDICARE: ROOSTER RIDGE STAIRLIFTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1639478282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOSTER RIDGE STAIRLIFTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1278
Second Line	:
City	:	WEST JEFFERSON
State	:	NC
Zip	:	28694-1278
Country	:	US
Telephone Number	:	336-877-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 ROOSTER RIDGE RD
Second Line	:
City	:	LANSING
State	:	NC
Zip	:	28643-9167
Country	:	US
Telephone Number	:	336-384-2415
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MS. VICKY LYNN MOODY
Credential	:
Telephone Number	:	336-877-2558

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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