Provider Demographics
NPI: | 1205394558 |
---|---|
Name: | FLINT RIDGE HEALTHCARE LLC |
Entity Type: | Organization |
Organization Name: | FLINT RIDGE HEALTHCARE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ATTORNEY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HAYLEY |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | WILLIAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 216-706-3936 |
Mailing Address - Street 1: | 15 AMERICA AVE UNIT 304 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKEWOOD |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08701-4582 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-487-7479 |
Mailing Address - Fax: | 732-276-5556 |
Practice Address - Street 1: | 1450 W MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | NEWARK |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43055-1825 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-348-1300 |
Practice Address - Fax: | 740-344-3091 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-03-06 |
Last Update Date: | 2019-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 1489N | Other | LICENSE |