Pheasant Ridge Facility Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PHEASANT RIDGE FACILITY OPERATIONS, LLC

Doing business as

Pheasant Ridge Nursing & Rehab Center

Practice address

4355 Pheasant Ridge Rd
Roanoke, VA 24014-5272

Phone

(540) 725-8210

Fax

(540) 725-5735

NPI assigned

Aug 3, 2006

Organization subpart

No

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

Authorized official

Name

Tim Lehner

Title

Manager

Phone

(770) 698-9040

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pheasant Ridge Nursing & Rehab Center Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1609884055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4355 PHEASANT RIDGE RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240145272",
            "telephone_number": "540-725-8210",
            "fax_number": "540-725-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4355 PHEASANT RIDGE RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240145272",
            "telephone_number": "540-725-8210",
            "fax_number": "540-725-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHEASANT RIDGE FACILITY OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "LEHNER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3001495494",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pheasant Ridge Nursing & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pheasant Ridge Nursing & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Skilled Nursing Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; 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.