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Organization
MSPF-IV RIDGEMAR OE, LP
Active
Organization
MSPF-IV RIDGEMAR OE, LP
Active
Other names
THE PLAZA AT RIDGEMAR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RONCK (PRESIDENT)
(214) 651-4050
Entity
Organization
Contact information
Practice address
6600 LANDS END CT, FORT WORTH, TX 76116-2100
(817) 665-1971
(817) 665-1977
Mailing address
3811 TURTLE CREEK BLVD, SUITE #1850, DALLAS, TX 75219-4402
(214) 651-4050
(214) 651-4001
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
116802
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5470
MEDICAID VENDOR
TX
Enumeration date
03/13/2008
Last updated
04/07/2008
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