Willow Ridge Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL060070 Issued in NC

Legal business name

WILLOW RIDGE ASSISTED LIVING LLC

Practice address

2140 Milton Rd
Charlotte, NC 28215-3319

Phone

(704) 563-7650

Fax

(704) 535-6950

NPI assigned

Feb 23, 2007

Organization subpart

No

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

Authorized official

Name

Kenneth Hodges

Title

Member Manager

Phone

(828) 738-3046

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willow Ridge Assisted Living Doing business as

Locations

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215063441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 MILTON RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282153319",
            "telephone_number": "704-563-7650",
            "fax_number": "704-535-6950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 MILTON RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282153319",
            "telephone_number": "704-563-7650",
            "fax_number": "704-535-6950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW RIDGE ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "828-738-3046"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL060070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805586",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Ridge Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Assisted Living Facility 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.