Provider Demographics
NPI:1033882469
Name:RIDGE FOR LIFE
Entity Type:Organization
Organization Name:RIDGE FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOUSIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-753-9964
Mailing Address - Street 1:25 WHITNEY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-8400
Mailing Address - Country:US
Mailing Address - Phone:513-753-9964
Mailing Address - Fax:
Practice Address - Street 1:4562 ST. RT. 222
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-4510
Practice Address - Country:US
Practice Address - Phone:513-753-9964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIDGE HVP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility