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General NPI Number Information
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NPI Number | 1851474274
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD RLC LLC
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 1624 HIGHLAND DRIVE
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City | WASHINGTON
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State | NC
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Zip | 27889
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Country | US
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Telephone | 252-946-9570
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Fax | 252-946-3715
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Provider Business Mailing Address
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Address Line | PO BOX 1868 1624 HIGHLAND DRIVE
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City | WASHINGTON
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State | NC
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Zip | 27889
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Country | US
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Telephone | 252-946-9570
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Fax | 252-946-3715
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL L KELLY
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Credential | NHA
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Telephone | 252-946-9570
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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 | NH0387
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License Number State | NC
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