Provider Demographics
NPI:1982854337
Name:NORTH RIDGE ASSISTED LIVING #4 AND #5
Entity Type:Organization
Organization Name:NORTH RIDGE ASSISTED LIVING #4 AND #5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:CASE
Authorized Official - Last Name:RATCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED ADMINISTRAT
Authorized Official - Phone:828-281-4863
Mailing Address - Street 1:119 RICHLAND STREET
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-4625
Mailing Address - Country:US
Mailing Address - Phone:828-281-4863
Mailing Address - Fax:828-281-4863
Practice Address - Street 1:75 KUYKENDALL BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-9612
Practice Address - Country:US
Practice Address - Phone:828-281-4863
Practice Address - Fax:828-281-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL011276310400000X
NCFCL011275310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805818Medicaid
NC7805827Medicaid