Provider Demographics
NPI:1356692800
Name:RIDGEWOOD PERSONAL CARE HOME, INC
Entity type:Organization
Organization Name:RIDGEWOOD PERSONAL CARE HOME, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBUAGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-471-4065
Mailing Address - Street 1:1065 MURRAY CIR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3927
Mailing Address - Country:US
Mailing Address - Phone:770-590-7297
Mailing Address - Fax:770-590-7297
Practice Address - Street 1:1065 MURRAY CIR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3927
Practice Address - Country:US
Practice Address - Phone:770-590-7297
Practice Address - Fax:770-590-7297
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIDGEWOOD PERSONAL CARE HOME, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities