Provider Demographics
NPI:1386631968
Name:PREFERRED HEALTH HOLDINGS II LLC
Entity Type:Organization
Organization Name:PREFERRED HEALTH HOLDINGS II LLC
Other - Org Name:RIDGEWOOD HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-221-4862
Mailing Address - Street 1:201 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-7496
Mailing Address - Country:US
Mailing Address - Phone:205-221-4862
Mailing Address - Fax:
Practice Address - Street 1:201 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-7496
Practice Address - Country:US
Practice Address - Phone:205-221-4862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREFERRED HEALTH HOLDINGS II
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10670314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4755010SMedicaid
AL4755010SMedicaid