Provider Demographics
NPI:1881689628
Name:NORTH RIDGE SKILLED, LLC
Entity Type:Organization
Organization Name:NORTH RIDGE SKILLED, LLC
Other - Org Name:NORTH RIDGE HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARNES
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-895-1797
Mailing Address - Street 1:5430 BOONE AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3615
Mailing Address - Country:US
Mailing Address - Phone:763-592-2600
Mailing Address - Fax:
Practice Address - Street 1:5430 BOONE AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3615
Practice Address - Country:US
Practice Address - Phone:763-492-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
MN327788314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN531716900Medicaid
MN530698100Medicaid
MN530698100Medicaid