Willow Ridge of NC, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0590 Issued in NC

Legal business name

WILLOW RIDGE OF NC, LLC

Practice address

237 Tryon Rd
Rutherfordton, NC 28139-3058

Phone

(828) 286-7200

Fax

(828) 287-3668

NPI assigned

Aug 8, 2006

Organization subpart

No

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

Authorized official

Name

Marcella Graf

Title

Executive Controller

Phone

(224) 377-2400

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Willow Ridge Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Willow Ridge Healthcare LLC

  • Skilled Nursing Facility
  • Rutherfordton, NC
  • NPI 1629425491
  NPD tax ID

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1609886159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 TRYON RD",
            "city": "RUTHERFORDTON",
            "state": "NC",
            "postal_code": "281393058",
            "telephone_number": "828-286-7200",
            "fax_number": "828-287-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 TRYON RD",
            "city": "RUTHERFORDTON",
            "state": "NC",
            "postal_code": "281393058",
            "telephone_number": "828-286-7200",
            "fax_number": "828-287-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW RIDGE OF NC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "GRAF",
        "authorized_official_first_name": "MARCELLA",
        "authorized_official_title_or_position": "EXECUTIVE CONTROLLER",
        "authorized_official_telephone_number": "224-377-2400"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3435197",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charlotte Patricia Whitaker, LCSW
• White Oak Manor Rutherfordton Inc
• Baylee Whiteside
• Dana Marie Williams, RPH
• Willow Ridge Healthcare LLC
• Sarah Lawing Wilson, LCSW
• Nancy Cornwell Winker, M.D.
• Wiseman SLP Services PLLC
• Krista Lee Wiseman, M.S., CCC-SLP
• Laura Elizabeth Wittwer, MD

• Skilled Nursing Facility in Rutherfordton, NC
• Providers in Rutherfordton, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.