Provider Demographics
NPI:1205295896
Name:SABER RIDGECREST MANOR
Entity type:Organization
Organization Name:SABER RIDGECREST MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:276-431-2841
Mailing Address - Street 1:1909 GLEN ECHO ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659
Mailing Address - Country:US
Mailing Address - Phone:423-418-3371
Mailing Address - Fax:
Practice Address - Street 1:157 ROSS CARTER BLVD
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244
Practice Address - Country:US
Practice Address - Phone:276-431-2841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility