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NPI Code Detail

MEDICARE: NORTH RIDGE SKILLED, LLC

MEDICARE: NORTH RIDGE SKILLED, 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
1310400000XAssisted Living FacilityMN
2314000000XSkilled Nursing Facility327788MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881689628
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH RIDGE SKILLED, LLC
Provider Business Mailing Address
First Line : 5430 BOONE AVE N
Second Line :
City : NEW HOPE
State : MN
Zip : 55428-3615
Country : US
Telephone Number : 763-592-2600
Fax Number :
Provider Business Practice Location Address
First Line : 5430 BOONE AVE N
Second Line :
City : NEW HOPE
State : MN
Zip : 55428-3615
Country : US
Telephone Number : 763-492-3000
Fax Number :
Authorized Official
Title or Position : DIRECTOR REVENUE CYCLE MANAGEMENT
Name : BARNES MICHELLE
Credential :
Telephone Number : 813-895-1797
Provider Enumeration Date : 09/19/2005
Last Update Date : 10/17/2019

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Directions to “NORTH RIDGE SKILLED, LLC ” Practice Location

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