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General NPI Number Information
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NPI Number | 1922479633
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Entity Type | Organization
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Legal Business Name | FOREST RIDGE SENIOR LIVING, LLC
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 16006 W JS HIGHWAY 24
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City | WOODLAND PARK
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State | CO
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Zip | 80863
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Country | US
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Telephone | 719-686-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 8820 HORIZON BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1689
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Country | US
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Telephone | 505-369-0079
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MRS. KELLEY WHITAKER
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Credential |
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Telephone | 505-369-0079
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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 | 02D453
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License Number State | CO
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