Provider Demographics
NPI:1598301806
Name:RIDGES AT PEORIA, LLC
Entity Type:Organization
Organization Name:RIDGES AT PEORIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBERR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-618-1682
Mailing Address - Street 1:1107 HAZELTINE BLVD, BOX 36
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:952-361-8935
Mailing Address - Fax:952-361-8060
Practice Address - Street 1:18170 N 91ST AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-0866
Practice Address - Country:US
Practice Address - Phone:623-974-5848
Practice Address - Fax:623-974-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility