Provider Demographics
NPI:1639472871
Name:RIDGEVIEW EXTENDED CARE LLC
Entity Type:Organization
Organization Name:RIDGEVIEW EXTENDED CARE LLC
Other - Org Name:MEADOWBROOK EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOUISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WINGET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-974-0006
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROKE
Mailing Address - State:GA
Mailing Address - Zip Code:31004-0069
Mailing Address - Country:US
Mailing Address - Phone:478-974-0006
Mailing Address - Fax:478-974-0046
Practice Address - Street 1:700 CORPORATE RDG
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5420
Practice Address - Country:US
Practice Address - Phone:205-991-8900
Practice Address - Fax:205-991-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-5462Medicare PIN