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General NPI Number Information
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NPI Number | 1134683881
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Entity Type | Organization
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Legal Business Name | RIVER RIDGE COMMUNITY LIVING
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 7129 OLD RICHMOND RD
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City | DANVILLE
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State | VA
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Zip | 24540-0217
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Country | US
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Telephone | 336-817-0635
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Fax |
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Provider Business Mailing Address
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Address Line | 1623 COUNTRY CLUB RD
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City | REIDSVILLE
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State | NC
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Zip | 27320-6101
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Country | US
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Telephone | 330-817-0635
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LAUREN GROGAN ELLIS
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Credential |
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Telephone | 336-817-0635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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