# RIDGEWOOD MANOR

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407280720
- **Authorized official:** MR. GREGORY M PETERSEN (PARTNER)
- **Authorized official phone:** (763) 607-6874

## Contact information

- **Practice address:** 10038 215TH AVE NW, ELK RIVER, MN 55330-8519
- **Practice address phone:** (763) 607-6874
- **Practice address fax:** (267) 350-9164
- **Mailing address:** 10038 215TH AVE NW, ELK RIVER, MN 55330-8519
- **Mailing address phone:** (763) 607-6874
- **Mailing address fax:** (267) 350-9164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 1066808-1-AFC | MN | Yes |

## Other

- **Enumeration date:** 08/22/2013
- **Last updated:** 08/22/2013