Provider Demographics
NPI:1336149772
Name:FRIENDSHIP RIDGE
Entity Type:Organization
Organization Name:FRIENDSHIP RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-770-3190
Mailing Address - Street 1:246 FRIENDSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9713
Mailing Address - Country:US
Mailing Address - Phone:724-775-7100
Mailing Address - Fax:
Practice Address - Street 1:246 FRIENDSHIP CIR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9713
Practice Address - Country:US
Practice Address - Phone:724-775-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0608OtherPROVIDER # FOR BLUE CROSS
PA0007564990004Medicaid
PA0413358MOtherUNEMPLOYMENT NUMBER
PA0608OtherPROVIDER # FOR BLUE CROSS
PA5122030001Medicare NSC