Provider Demographics
NPI:1417619743
Name:RIDGEMONT FAMILY CARE LLC
Entity Type:Organization
Organization Name:RIDGEMONT FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:PROF
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-207-8755
Mailing Address - Street 1:305 PLAZA TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3331
Mailing Address - Country:US
Mailing Address - Phone:757-207-8755
Mailing Address - Fax:
Practice Address - Street 1:305 PLAZA TRAIL CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3331
Practice Address - Country:US
Practice Address - Phone:757-207-8755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services