Provider Demographics
NPI:1033288899
Name:RIDGEWAY RESIDENTIAL CARE
Entity type:Organization
Organization Name:RIDGEWAY RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-608-5918
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:431 RUSSELL ROAD
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-0267
Mailing Address - Country:US
Mailing Address - Phone:314-608-5918
Mailing Address - Fax:573-468-5368
Practice Address - Street 1:431 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2228
Practice Address - Country:US
Practice Address - Phone:314-608-5918
Practice Address - Fax:573-468-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267903607Medicaid