Provider Demographics
NPI:1902880230
Name:COPPER RIDGE, INC.
Entity type:Organization
Organization Name:COPPER RIDGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-787-4104
Mailing Address - Street 1:420 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2711
Mailing Address - Country:US
Mailing Address - Phone:267-787-4097
Mailing Address - Fax:215-699-2065
Practice Address - Street 1:710 OBRECHT RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7650
Practice Address - Country:US
Practice Address - Phone:410-795-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06AL0180311500000X
MD06018314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
215265Medicare ID - Type Unspecified