# RIDGEWOOD RLC LLC

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

## Provider details

- **NPI number:** 1851474274
- **Authorized official:** MR. MICHAEL L KELLY NHA (ADMINISTRATOR)
- **Authorized official phone:** (252) 946-9570

## Contact information

- **Practice address:** 1624 HIGHLAND DRIVE, WASHINGTON, NC 27889
- **Practice address phone:** (252) 946-9570
- **Practice address fax:** (252) 946-3715
- **Mailing address:** PO BOX 1868, 1624 HIGHLAND DRIVE, WASHINGTON, NC 27889
- **Mailing address phone:** (252) 946-9570
- **Mailing address fax:** (252) 946-3715

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH0387 | NC | Yes |

## Other

- **Enumeration date:** 10/21/2006
- **Last updated:** 11/08/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00966 | BLUE CROSS BLUE SHIELD | NC |
| 01 | — | 3406346 | MEDICAID ICF | NC |
| 05 | — | 3415228 | — | NC |