Healthcare Provider Details

I. General information

NPI: 1861357089
Provider Name (Legal Business Name): HAWTHORNE RIDGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 COMMUNITY WAY
EAST GREENBUSH NY
12061-3925
US

IV. Provider business mailing address

30 COMMUNITY WAY
EAST GREENBUSH NY
12061-3925
US

V. Phone/Fax

Practice location:
  • Phone: 518-833-1111
  • Fax:
Mailing address:
  • Phone: 518-833-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BARTELS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 518-279-5501