Healthcare Provider Details

I. General information

NPI: 1427169564
Provider Name (Legal Business Name): RIDGECREST HEALTHCARE GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 RIDGE AVE SE
WARREN OH
44484-2821
US

IV. Provider business mailing address

1926 RIDGE AVE SE
WARREN OH
44484-2821
US

V. Phone/Fax

Practice location:
  • Phone: 330-369-4672
  • Fax: 330-369-2367
Mailing address:
  • Phone: 330-369-4672
  • Fax: 330-369-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0517N
License Number StateOH

VIII. Authorized Official

Name: WILLIAM I WEISBERG
Title or Position: ITS VP
Credential:
Phone: 216-292-5706