Provider Demographics
NPI:1134305436
Name:WOODRIDGE NORTHEAST, LLC
Entity Type:Organization
Organization Name:WOODRIDGE NORTHEAST, LLC
Other - Org Name:PERIMETER BEHAVIORAL OF WEST MEMPHIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-554-7903
Mailing Address - Street 1:2520 NORTHWINDS PKWY STE 550
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2236
Mailing Address - Country:US
Mailing Address - Phone:470-554-7902
Mailing Address - Fax:
Practice Address - Street 1:600 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301
Practice Address - Country:US
Practice Address - Phone:870-394-7100
Practice Address - Fax:870-394-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166757125Medicaid