Provider Demographics
NPI:1265536304
Name:RIDGEVIEW HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:RIDGEVIEW HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:205-221-9111
Mailing Address - Street 1:903 11TH ST NE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-8821
Mailing Address - Country:US
Mailing Address - Phone:205-221-9111
Mailing Address - Fax:205-387-1912
Practice Address - Street 1:907 11TH ST NE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-8821
Practice Address - Country:US
Practice Address - Phone:205-221-9111
Practice Address - Fax:205-387-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN6401332BP3500X
AL12697314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4753280SMedicaid
AL010685OtherBLUE CROSS PROVIDER NUMBE
AL40232OtherHEALTHSPRINGS PROVIDER NU
AL40232OtherHEALTHSPRINGS PROVIDER NU
AL4753280SMedicaid