Provider Demographics
NPI:1275806838
Name:HERITAGE RIDGE OPERATING LLC
Entity Type:Organization
Organization Name:HERITAGE RIDGE OPERATING LLC
Other - Org Name:HERITAGE RIDGE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-932-1881
Mailing Address - Street 1:1502 FORT CROOK RD S
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2972
Mailing Address - Country:US
Mailing Address - Phone:402-932-1881
Mailing Address - Fax:402-916-5500
Practice Address - Street 1:1502 FORT CROOK RD S
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2972
Practice Address - Country:US
Practice Address - Phone:402-932-1881
Practice Address - Fax:402-916-5500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE MANAGEMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility