Rudd Ridge Family Care Home Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

FCL-017-039 Issued in NC

Legal business name

RUDD RIDGE FAMILY CARE HOME INC.

Practice address

643 Rudd Ridge Rd
Yanceyville, NC 27379-8460

Phone

(336) 421-7341

NPI assigned

Aug 18, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tonya B. Ribelin

Title

Co-Owner / Administrator

Phone

(336) 421-7341

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063526002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 RUDD RIDGE RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 RUDD RIDGE RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273798460",
            "telephone_number": "336-421-7341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUDD RIDGE FAMILY CARE HOME INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIBELIN",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CO-OWNER / ADMINISTRATOR",
        "authorized_official_telephone_number": "336-421-7341",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NC",
            "license": "FCL-017-039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804636",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Yanceyville, NC
• Providers in Yanceyville, NC by specialty
• Primary Care Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.