Provider Demographics
NPI:1174662720
Name:WOODRIDGE OF MISSOURI, INC.
Entity Type:Organization
Organization Name:WOODRIDGE OF MISSOURI, INC.
Other - Org Name:PINEY RIDGE CENTER
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:470-554-7903
Mailing Address - Fax:
Practice Address - Street 1:1000 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-4067
Practice Address - Country:US
Practice Address - Phone:573-774-5353
Practice Address - Fax:573-774-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000380592322D00000X, 323P00000X, 324500000X
MO30888669324500000X
MO3088-11051324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility