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NPI Code Detail

MEDICARE: LIME RIDGE HEALTHCARE, LLC

MEDICARE: LIME RIDGE HEALTHCARE, 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1902505746
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIME RIDGE HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 262 N UNIVERSITY AVE
Second Line :
City : FARMINGTON
State : UT
Zip : 84025-2975
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1050 SAN MIGUEL RD
Second Line :
City : CONCORD
State : CA
Zip : 94518-2094
Country : US
Telephone Number : 925-825-4280
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : JOHN MITCHELL
Credential :
Telephone Number : 385-988-3319
Provider Enumeration Date : 03/01/2023
Last Update Date : 08/20/2024

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Directions to “LIME RIDGE HEALTHCARE, LLC ” Practice Location

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