Forest Ridge Assissted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-005-015 Issued in NC

Legal business name

FOREST RIDGE ASSISSTED LIVING, LLC

Practice address

151 Village Park Dr
West Jefferson, NC 28694-6015

Phone

(336) 846-1008

NPI assigned

Jul 19, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Steven E Bailey, CFO

Title

Member Manager

Phone

(336) 993-7555

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342656000000",
    "number": "1326393935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 VILLAGE PARK DR",
            "city": "WEST JEFFERSON",
            "state": "NC",
            "postal_code": "286946015",
            "telephone_number": "336-846-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 VILLAGE PARK DR",
            "city": "WEST JEFFERSON",
            "state": "NC",
            "postal_code": "286946015",
            "telephone_number": "336-846-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST RIDGE ASSISSTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-19",
        "last_updated": "2012-07-19",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "336-993-7555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-005-015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "APPLIED FOR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Michael Edwards, PMHNP-BC
• Adam Tracy Elliott, ATC
• Emily J. Stopper, DDS, PLLC
• Lisa Factor, LPCA
• Robert N. Fernandez
• Amanda Beth Francis, PHARM.D.
• Kyoko Funabashi
• Kimberly Barlow Furches, MA, LMFT
• Michael Griffith
• Jordain Dollar Hardin, FNP-C

• Assisted Living Facility in West Jefferson, NC
• Providers in West Jefferson, 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 Jul 19, 2012; 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.