Provider Demographics
NPI:1972659696
Name:HIGH RIDGE HOUSE, INC.
Entity Type:Organization
Organization Name:HIGH RIDGE HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-890-3427
Mailing Address - Street 1:5959 INDEPENDENCE AVE.
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1299
Mailing Address - Country:US
Mailing Address - Phone:718-796-4200
Mailing Address - Fax:718-549-3465
Practice Address - Street 1:5959 INDEPENDENCE AVE.
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10471-1299
Practice Address - Country:US
Practice Address - Phone:718-796-4200
Practice Address - Fax:718-549-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331990Medicare ID - Type Unspecified