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General NPI Number Information
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NPI Number | 1174342752
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Entity Type | Organization
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Legal Business Name | RIDGELINE SOUTH JORDAN LLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 2664 WEST 11400 SOUTH
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City | SOUTH JORDAN
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State | UT
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Zip | 84095
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Country | US
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Telephone | 801-260-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 2095 SUMMER LEE DR. SUITE 207
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City | ROCKWALL
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State | TX
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Zip | 75032-5438
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Country | US
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Telephone | 469-745-8277
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | CHRISTINA CHAFFIN
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Credential |
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Telephone | 469-745-8277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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