Provider Demographics
NPI:1740770551
Name:RIDGEWAY MANOR HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:RIDGEWAY MANOR HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRARD
Authorized Official - Suffix:V
Authorized Official - Credentials:
Authorized Official - Phone:863-226-0358
Mailing Address - Street 1:117 BELLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-8261
Mailing Address - Country:US
Mailing Address - Phone:863-226-0358
Mailing Address - Fax:863-968-1816
Practice Address - Street 1:117 BELLEFIELD RD
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:SC
Practice Address - Zip Code:29130-8261
Practice Address - Country:US
Practice Address - Phone:863-226-0358
Practice Address - Fax:863-968-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-0981314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF-1087Medicaid