Provider Demographics
NPI:1902847361
Name:RIDGEWOOD TERRACE, LLC
Entity Type:Organization
Organization Name:RIDGEWOOD TERRACE, LLC
Other - Org Name:RIDGEWOOD TERRACE HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-825-2528
Mailing Address - Street 1:150 CORNWALL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8781
Mailing Address - Country:US
Mailing Address - Phone:270-825-0166
Mailing Address - Fax:270-825-0169
Practice Address - Street 1:150 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8781
Practice Address - Country:US
Practice Address - Phone:270-825-0166
Practice Address - Fax:270-825-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100627314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504577Medicaid
KY100627OtherLICENSE