Provider Demographics
NPI:1376343376
Name:RIDGEWOOD SENIOR LIVING AT HISTORIC SMITHVILLE, LLC
Entity type:Organization
Organization Name:RIDGEWOOD SENIOR LIVING AT HISTORIC SMITHVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-746-1700
Mailing Address - Street 1:705 E MOSS MILL RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4219
Mailing Address - Country:US
Mailing Address - Phone:609-573-9607
Mailing Address - Fax:
Practice Address - Street 1:705 E MOSS MILL RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4219
Practice Address - Country:US
Practice Address - Phone:609-746-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility