Provider Demographics
NPI:1700952504
Name:STONERIDGE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:STONERIDGE HEALTH CARE, LLC
Other - Org Name:RIDGETOP HAVEN HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-859-5895
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:RIDGETOP
Mailing Address - State:TN
Mailing Address - Zip Code:37152-0379
Mailing Address - Country:US
Mailing Address - Phone:615-859-5895
Mailing Address - Fax:615-859-6789
Practice Address - Street 1:2002 GREER RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-7166
Practice Address - Country:US
Practice Address - Phone:615-859-5895
Practice Address - Fax:615-859-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN215313M00000X, 314000000X
313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440415Medicaid
445486Medicare Oscar/Certification