Provider Demographics
NPI:1023007648
Name:RIDGEWAY NURSING & REHABILITATION FACILITY LLC
Entity Type:Organization
Organization Name:RIDGEWAY NURSING & REHABILITATION FACILITY LLC
Other - Org Name:RIDGEWAY NURSING AND REHABILITATION FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF ADMINISTRATIVE SUPPORT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-0898
Mailing Address - Street 1:300 PROVIDER CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8488
Mailing Address - Country:US
Mailing Address - Phone:859-623-0898
Mailing Address - Fax:859-623-0843
Practice Address - Street 1:406 WYOMING ROAD
Practice Address - Street 2:
Practice Address - City:OWINGSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40360-8842
Practice Address - Country:US
Practice Address - Phone:606-674-6613
Practice Address - Fax:606-674-9418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504544Medicaid
KY90160763Medicaid
KY12504544Medicaid
KY4334100001Medicare NSC