Ridgewood RLC LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0387 Issued in NC

Legal business name

RIDGEWOOD RLC LLC

Practice address

1624 Highland Drive
Washington, NC 27889

Phone

(252) 946-9570

Fax

(252) 946-3715

NPI assigned

Oct 21, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael L Kelly, NHA

Title

Administrator

Phone

(252) 946-9570

Specialties & licenses 1

Addresses

Other identifiers 3

Tax ID family

Ridgewood 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.

• Ridgewood Healthcare LLC

  dba Ridgewood Living and Rehabilitation Center

  • Skilled Nursing Facility
  • Washington, NC
  • NPI 1306293170
  NPD tax ID

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1851474274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1868",
            "address_2": "1624 HIGHLAND DRIVE",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "27889",
            "telephone_number": "252-946-9570",
            "fax_number": "252-946-3715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 HIGHLAND DRIVE",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "27889",
            "telephone_number": "252-946-9570",
            "fax_number": "252-946-3715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGEWOOD RLC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-21",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "252-946-9570",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00966",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID ICF",
            "identifier": "3406346",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415228",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hector Kiowa Reynoso, PHARMD, RPH
• Daniel Dale Richardson, M.D.
• Jennifer Marzolf Richardson, F.N.P.
• Abigeal Riddle, PMHNP
• Ridgewood Healthcare LLC (Ridgewood Living and Rehabilitation Center)
• Patrick M Riley, MD
• Jessica Rispoli
• Roberson Foot Care, PA
• Roberson Taxicab Service
• Donna Kay Roberson, LCASA

• Skilled Nursing Facility in Washington, NC
• Providers in Washington, 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 Nov 8, 2010; 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.