Healthcare Provider Details

I. General information

NPI: 1245422187
Provider Name (Legal Business Name): RIDGILL JOHNSON PROPERTIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3557 ATLANTIC AVENUE SUITE 188
LONG BEACH CA
90807
US

IV. Provider business mailing address

3557 ATLANTIC AVENUE SUITE 188
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-8405
  • Fax: 877-750-3008
Mailing address:
  • Phone: 310-248-8405
  • Fax: 877-750-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000075
License Number StateCA

VIII. Authorized Official

Name: BYRON JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 310-242-8405