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NPI Code Detail

MEDICARE: CHRIS RIDGE VILLAGE HEALTH CARE CENTER

MEDICARE: CHRIS RIDGE VILLAGE HEALTH CARE CENTER
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 FacilityNCI-367AZ

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 : 1649268657
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRIS RIDGE VILLAGE HEALTH CARE CENTER
Provider Business Mailing Address
First Line : 6246 N 19TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1511
Country : US
Telephone Number : 602-433-6300
Fax Number : 602-433-5458
Provider Business Practice Location Address
First Line : 6246 N 19TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1511
Country : US
Telephone Number : 602-433-6300
Fax Number : 602-433-5458
Authorized Official
Title or Position : ADMINISTRATOR
Name : TERESA WILLIAMSON
Credential :
Telephone Number : 602-433-6300
Provider Enumeration Date : 10/12/2005
Last Update Date : 09/28/2007

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Directions to “CHRIS RIDGE VILLAGE HEALTH CARE CENTER ” Practice Location

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