Provider Demographics
NPI:1952595993
Name:LOUISA RIDGE ADULT DAY SERVICES INC
Entity Type:Organization
Organization Name:LOUISA RIDGE ADULT DAY SERVICES INC
Other - Org Name:SUNRISE ADULT DAY SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARICKA
Authorized Official - Middle Name:LATOYA
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:330-945-4115
Mailing Address - Street 1:975 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1165
Mailing Address - Country:US
Mailing Address - Phone:330-945-4115
Mailing Address - Fax:330-945-5967
Practice Address - Street 1:975 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1165
Practice Address - Country:US
Practice Address - Phone:330-945-4115
Practice Address - Fax:330-945-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2118998Medicaid