Provider Demographics
NPI:1437270634
Name:SILVER RIDGE MANAGEMENT INC
Entity Type:Organization
Organization Name:SILVER RIDGE MANAGEMENT INC
Other - Org Name:THE LEGACY REHAB & CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KIDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-718-4852
Mailing Address - Street 1:2812 SILVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8309
Mailing Address - Country:US
Mailing Address - Phone:928-763-1404
Mailing Address - Fax:928-763-9795
Practice Address - Street 1:2812 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8309
Practice Address - Country:US
Practice Address - Phone:928-763-1404
Practice Address - Fax:928-763-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-2664314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ304755Medicaid
AZ304755Medicaid
AZ=========OtherTAX ID