# EAGLE RIDGE PERSONAL CARE HOME LLC

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

## Provider details

- **NPI number:** 1659055390
- **Authorized official:** LINDSEY PENLAND (PRESIDENT)
- **Authorized official phone:** (570) 367-1899

## Contact information

- **Practice address:** 2997 RENOVO RD, MILL HALL, PA 17751-8537
- **Practice address phone:** (570) 367-1899
- **Mailing address:** 2997 RENOVO RD, MILL HALL, PA 17751-8537
- **Mailing address phone:** (570) 367-1899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 06/13/2023
- **Last updated:** 06/13/2023