Healthcare Provider Details

I. General information

NPI: 1770271462
Provider Name (Legal Business Name): RIDGEMOOR CASE MANAGEMENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INTERNATIONAL DR APT 642
CAPE CANAVERAL FL
32920-3675
US

IV. Provider business mailing address

PO BOX 6525
GRAND RAPIDS MI
49516-6525
US

V. Phone/Fax

Practice location:
  • Phone: 616-437-0545
  • Fax: 616-245-0107
Mailing address:
  • Phone: 616-325-1212
  • Fax: 616-245-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY LOU STOWE
Title or Position: OWNER/SUPERVISOR
Credential: RN
Phone: 616-325-1212