Provider Demographics
NPI:1467585422
Name:RIDGECREST RITIREMENT COMMUNITY
Entity Type:Organization
Organization Name:RIDGECREST RITIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:BONDURANT
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-786-9100
Mailing Address - Street 1:RIDGECREST RETIREMENT COMMUNITY
Mailing Address - Street 2:1000 RIDGECREST LANE
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27041
Mailing Address - Country:US
Mailing Address - Phone:336-786-9100
Mailing Address - Fax:336-786-2899
Practice Address - Street 1:RIDGECREST RETIREMENT, LLC
Practice Address - Street 2:1000 RIDGECREST LN.
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030
Practice Address - Country:US
Practice Address - Phone:336-786-9100
Practice Address - Fax:336-786-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL086010310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility