Provider Demographics
NPI:1376326595
Name:VILLA AT RIVER RIDGE
Entity Type:Organization
Organization Name:VILLA AT RIVER RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-498-0195
Mailing Address - Street 1:1415 YELLOWSTONE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1834
Mailing Address - Country:US
Mailing Address - Phone:406-245-9330
Mailing Address - Fax:
Practice Address - Street 1:947 S 500 E STE 105
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3392
Practice Address - Country:US
Practice Address - Phone:385-492-0194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility