Provider Demographics
NPI:1942618319
Name:CHAPEL RIDGE ASSISTED LIVING
Entity Type:Organization
Organization Name:CHAPEL RIDGE ASSISTED LIVING
Other - Org Name:CHAPEL RIDGE LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-562-0303
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0534
Mailing Address - Country:US
Mailing Address - Phone:573-562-0303
Mailing Address - Fax:573-562-7743
Practice Address - Street 1:10160 RESTORATION CIRCLE
Practice Address - Street 2:
Practice Address - City:MINERAL POINT
Practice Address - State:MO
Practice Address - Zip Code:63660
Practice Address - Country:US
Practice Address - Phone:573-562-0303
Practice Address - Fax:573-562-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042272310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility