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NPI Code Detail

MEDICARE: RIDGEMONT TERRACE INC

MEDICARE: RIDGEMONT TERRACE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH588WA
2225X00000XOccupational TherapistNH588WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033119649
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIDGEMONT TERRACE INC
Provider Business Mailing Address
First Line : 2051 POTTERY AVE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-2010
Country : US
Telephone Number : 360-876-4461
Fax Number : 360-876-4482
Provider Business Practice Location Address
First Line : 2051 POTTERY AVE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-2010
Country : US
Telephone Number : 360-876-4461
Fax Number : 360-876-4482
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. RICHARD E CHASTEEN
Credential :
Telephone Number : 360-876-4461
Provider Enumeration Date : 07/26/2005
Last Update Date : 09/11/2025

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Directions to “RIDGEMONT TERRACE INC ” Practice Location

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