Provider Demographics
NPI:1689697344
Name:RIDGECREST RETIREMENT CENTER AND HEALTHCARE
Entity Type:Organization
Organization Name:RIDGECREST RETIREMENT CENTER AND HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-776-9681
Mailing Address - Street 1:1900 W STATE HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-9729
Mailing Address - Country:US
Mailing Address - Phone:254-776-9681
Mailing Address - Fax:254-776-7960
Practice Address - Street 1:1900 W STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-9729
Practice Address - Country:US
Practice Address - Phone:254-776-9681
Practice Address - Fax:254-776-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5212314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455670Medicare ID - Type Unspecified