Healthcare Provider Details

I. General information

NPI: 1598301806
Provider Name (Legal Business Name): RIDGES AT PEORIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18170 N 91ST AVE
PEORIA AZ
85382-0866
US

IV. Provider business mailing address

1107 HAZELTINE BLVD, BOX 36
CHASKA MN
55318-1009
US

V. Phone/Fax

Practice location:
  • Phone: 623-974-5848
  • Fax: 623-974-3831
Mailing address:
  • Phone: 952-361-8935
  • Fax: 952-361-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES A WEICHERT
Title or Position: BOARD MEMBERR
Credential:
Phone: 612-618-1682