Healthcare Provider Details

I. General information

NPI: 1629425491
Provider Name (Legal Business Name): WILLOW RIDGE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 TRYON RD
RUTHERFORDTON NC
28139-3058
US

IV. Provider business mailing address

100 ROUTE 70 STE 3
LAKEWOOD NJ
08701-7406
US

V. Phone/Fax

Practice location:
  • Phone: 828-286-7200
  • Fax: 828-287-3668
Mailing address:
  • Phone: 732-659-1353
  • Fax: 866-306-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB S. STERN
Title or Position: MANAGER
Credential:
Phone: 732-659-1353