Healthcare Provider Details

I. General information

NPI: 1225363468
Provider Name (Legal Business Name): RIDGECREST REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 TRIANGLE DR STE 200
RIDGECREST CA
93555-2614
US

IV. Provider business mailing address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-3617
  • Fax: 760-499-3614
Mailing address:
  • Phone: 760-446-3551
  • Fax: 760-446-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMES ASHLEY SUVER
Title or Position: CEO
Credential:
Phone: 760-499-3900