Provider Demographics
NPI:1558487553
Name:RIDGEWOOD NURSING HOME HEALTH, LLC
Entity Type:Organization
Organization Name:RIDGEWOOD NURSING HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVLICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-739-7671
Mailing Address - Street 1:11 ZIMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1121
Mailing Address - Country:US
Mailing Address - Phone:201-739-7671
Mailing Address - Fax:
Practice Address - Street 1:11 ZIMMER AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1121
Practice Address - Country:US
Practice Address - Phone:201-739-7671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N011880500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty