Provider Demographics
NPI:1225024946
Name:ISABELLE RIDGWAY CARE CENTER, INC.
Entity Type:Organization
Organization Name:ISABELLE RIDGWAY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-252-4931
Mailing Address - Street 1:1520 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1762
Mailing Address - Country:US
Mailing Address - Phone:614-252-4931
Mailing Address - Fax:614-252-5911
Practice Address - Street 1:1520 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1762
Practice Address - Country:US
Practice Address - Phone:614-252-4931
Practice Address - Fax:614-252-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1605N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305708Medicaid
5574410001Medicare NSC
OH366207Medicare ID - Type UnspecifiedPROVIDER ID