=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346242682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIDGEVIEW INSTITUTE,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 07/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3995 S COBB DR SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-6342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-434-4567
-----------------------------------------------------
Fax | 770-431-7045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3995 S COBB DR SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-6342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-434-4567
-----------------------------------------------------
Fax | 770-431-7045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MRS. MONICA TIPPETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-434-4568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number | 033-304
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 033-304
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------