Organization
200 SOUTH RITCHIE AVENUE OPERATIONS LLC
Active
Other names
Ravenswood Village
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
200 S RITCHIE AVE, RAVENSWOOD, WV 26164-1721
(304) 273-9385
(304) 273-9387
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 925-4351
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
122
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002860000
—
WV
Enumeration date
12/24/2007
Last updated
05/02/2016
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