Provider Demographics
NPI:1265649768
Name:RIDGECREST HEALTHCARE, INC.
Entity Type:Organization
Organization Name:RIDGECREST HEALTHCARE, INC.
Other - Org Name:RIDGECREST HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PAREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-494-4386
Mailing Address - Street 1:1131 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3131
Mailing Address - Country:US
Mailing Address - Phone:760-446-3591
Mailing Address - Fax:323-344-8900
Practice Address - Street 1:1131 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3131
Practice Address - Country:US
Practice Address - Phone:760-446-3591
Practice Address - Fax:323-344-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALTC55248G320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55248GMedicaid
CALTC55248GMedicaid