Ridgewood Manor

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

1066808-1-AFC Issued in MN

Legal business name

RIDGEWOOD MANOR

Practice address

10038 215TH Ave NW
Elk River, MN 55330-8519

Phone

(763) 607-6874

Fax

(267) 350-9164

NPI assigned

Aug 22, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Gregory M Petersen

Title

Partner

Phone

(763) 607-6874

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1377129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377129600000",
    "number": "1407280720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10038 215TH AVE NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553308519",
            "telephone_number": "763-607-6874",
            "fax_number": "267-350-9164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10038 215TH AVE NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553308519",
            "telephone_number": "763-607-6874",
            "fax_number": "267-350-9164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGEWOOD MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-22",
        "last_updated": "2013-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "763-607-6874",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MN",
            "license": "1066808-1-AFC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra Lynn Rebrovich, D.C.
• Regroup Counseling and Consulting PSC
• Courtney E Reinitz, MSW, LICSW
• Rescare Minnesota
• Perla Reyes-Mendoza
• Madeline Marie Riebel
• River Place by Serenity, LLC
• Bobbie Marie Rivera
• Heather Jean Roberts, LPC
• Sadie Leigh-Ann Roberts

• Adult Care Home Facility in Elk River, MN
• Providers in Elk River, MN by specialty
• Adult Care Home Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.