Provider Demographics
NPI:1659055390
Name:EAGLE RIDGE PERSONAL CARE HOME LLC
Entity Type:Organization
Organization Name:EAGLE RIDGE PERSONAL CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-367-1899
Mailing Address - Street 1:2997 RENOVO RD
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-8537
Mailing Address - Country:US
Mailing Address - Phone:570-367-1899
Mailing Address - Fax:
Practice Address - Street 1:2997 RENOVO RD
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-8537
Practice Address - Country:US
Practice Address - Phone:570-367-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility