Provider Demographics
NPI:1811064959
Name:RIDGAWAY PHILIPS OF DE, INC
Entity type:Organization
Organization Name:RIDGAWAY PHILIPS OF DE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-1200
Mailing Address - Street 1:908 CHURCHMANS ROAD EXT
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3109
Mailing Address - Country:US
Mailing Address - Phone:302-323-1436
Mailing Address - Fax:302-323-1481
Practice Address - Street 1:908 CHURCHMANS ROAD EXT
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3109
Practice Address - Country:US
Practice Address - Phone:302-323-1436
Practice Address - Fax:302-323-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2003109630251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001987000OtherIBC
PA0001987000OtherAMERIHEALTH HMO
DE157A46OtherBC BS OF DE
KY201484OtherCOVENTRY HEALTH CARE
PA0001990000OtherIBC
DE1000024008Medicaid
CT1526OtherGENTIVA
TX4492440OtherAETNA
AZ1000033612OtherDE PHYSICIANS CARE, INC
TX3333942OtherAETNA LIFE INS, CO
DE5701000157A460OtherINDEPENDENT LICENSE BC BS
PA0001989000OtherKEYSTONE HEALTH PLAN
PA0001990000OtherKEYSTONE HEALTH PLAN
PA0001987000OtherKEYSTONE HEALTH PLAN
PA0001989000OtherIBC
PA0001989000OtherAMERIHEALTH HMO
PA0001990000OtherAMERIHEALTH HMO