Provider Demographics
NPI:1932749025
Name:RIDGEVIEW ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:RIDGEVIEW ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-324-1200
Mailing Address - Street 1:2020 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-3829
Mailing Address - Country:US
Mailing Address - Phone:218-283-2806
Mailing Address - Fax:218-283-2177
Practice Address - Street 1:2020 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-3829
Practice Address - Country:US
Practice Address - Phone:218-283-2806
Practice Address - Fax:218-283-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility