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General NPI Number Information
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NPI Number | 1033119649
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Entity Type | Organization
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Legal Business Name | RIDGEMONT TERRACE INC
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2051 POTTERY AVE
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City | PORT ORCHARD
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State | WA
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Zip | 98366-2010
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Country | US
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Telephone | 360-876-4461
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Fax | 360-876-4482
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Provider Business Mailing Address
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Address Line | 2051 POTTERY AVE
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City | PORT ORCHARD
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State | WA
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Zip | 98366-2010
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Country | US
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Telephone | 360-876-4461
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Fax | 360-876-4482
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RICHARD E CHASTEEN
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Credential |
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Telephone | 360-876-4461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH588
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | NH588
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License Number State | WA
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