Provider Demographics
NPI:1245422187
Name:RIDGILL JOHNSON PROPERTIES, INC
Entity Type:Organization
Organization Name:RIDGILL JOHNSON PROPERTIES, INC
Other - Org Name:AVALON VILLA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-242-8405
Mailing Address - Street 1:3557 ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 188
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:310-248-8405
Mailing Address - Fax:877-750-3008
Practice Address - Street 1:3557 ATLANTIC AVENUE
Practice Address - Street 2:SUITE 188
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:310-248-8405
Practice Address - Fax:877-750-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000075314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056023Medicare Oscar/Certification