Healthcare Provider Details

I. General information

NPI: 1972659696
Provider Name (Legal Business Name): HIGH RIDGE HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 INDEPENDENCE AVE.
RIVERDALE NY
10471-1299
US

IV. Provider business mailing address

5959 INDEPENDENCE AVE.
RIVERDALE NY
10471-1299
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-4200
  • Fax: 718-549-3465
Mailing address:
  • Phone: 718-796-4200
  • Fax: 718-549-3465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: SUSAN M WEST
Title or Position: BUSINESS MANAGER
Credential:
Phone: 972-890-3427