MEDICARE: RIDGECREST NURSING AND REHAB LLC

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
1	314000000X	Skilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1033867478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGECREST NURSING AND REHAB LLC

Provider Business Mailing Address
First Line	:	1200 N STONE ST
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-2511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N STONE ST
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-2511
Country	:	US
Telephone Number	:	386-734-4334
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MOSHE SCHEINER
Credential	:
Telephone Number	:	845-490-6060

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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