Provider Demographics
NPI:1790532083
Name:RIDGEMONT AFH LLC
Entity type:Organization
Organization Name:RIDGEMONT AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT CARE HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NJAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-751-5404
Mailing Address - Street 1:4405 LANDIS CT SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-8813
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4405 LANDIS CT SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-8813
Practice Address - Country:US
Practice Address - Phone:206-751-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home