Organization
RIDGEWOOD RLC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL L KELLY NHA (ADMINISTRATOR)
(252) 946-9570
Entity
Organization
Contact information
Practice address
1624 HIGHLAND DRIVE, WASHINGTON, NC 27889
(252) 946-9570
(252) 946-3715
Mailing address
PO BOX 1868, 1624 HIGHLAND DRIVE, WASHINGTON, NC 27889
(252) 946-9570
(252) 946-3715
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0387
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00966
BLUE CROSS BLUE SHIELD
NC
01
—
3406346
MEDICAID ICF
NC
05
—
3415228
—
NC
Enumeration date
10/21/2006
Last updated
11/08/2010
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