Provider Demographics
NPI:1003849506
Name:MINERAL RIDGE SKILLED NURSING AND RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:MINERAL RIDGE SKILLED NURSING AND RESIDENTIAL CARE, LLC
Other - Org Name:CONTINUING HEALTHCARE AT THE RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-772-1105
Mailing Address - Street 1:2875 CENTER RD STE 6
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2319
Mailing Address - Country:US
Mailing Address - Phone:216-772-1105
Mailing Address - Fax:
Practice Address - Street 1:3379 MAIN ST
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9735
Practice Address - Country:US
Practice Address - Phone:330-652-9901
Practice Address - Fax:330-544-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1218R310400000X
OH1218N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2658271Medicaid
OH167615174OtherMEDICAID ASSISTANT LIVING WAIVER
OH365823Medicare Oscar/Certification
OH5775880001Medicare NSC