Provider Demographics
NPI:1801951926
Name:ROLLING RIDGE RETIREMENT CENTER
Entity type:Organization
Organization Name:ROLLING RIDGE RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEONORE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETRUSEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-594-2100
Mailing Address - Street 1:700 MOUNT OLIVE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28366-7741
Mailing Address - Country:US
Mailing Address - Phone:910-594-2100
Mailing Address - Fax:910-594-2698
Practice Address - Street 1:700 MOUNT OLIVE DR
Practice Address - Street 2:
Practice Address - City:NEWTON GROVE
Practice Address - State:NC
Practice Address - Zip Code:28366-7741
Practice Address - Country:US
Practice Address - Phone:910-594-2100
Practice Address - Fax:910-594-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL082007311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803505Medicaid