Healthcare Provider Details

I. General information

NPI: 1689697344
Provider Name (Legal Business Name): RIDGECREST RETIREMENT CENTER AND HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W STATE HIGHWAY 6
WACO TX
76712-9729
US

IV. Provider business mailing address

1900 W STATE HIGHWAY 6
WACO TX
76712-9729
US

V. Phone/Fax

Practice location:
  • Phone: 254-776-9681
  • Fax: 254-776-7960
Mailing address:
  • Phone: 254-776-9681
  • Fax: 254-776-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5212
License Number StateTX

VIII. Authorized Official

Name: ANGIE F CONN
Title or Position: DON
Credential: RN
Phone: 254-776-9681