Provider Demographics
NPI:1306355144
Name:RIDGEVIEW RECOVERY LLC
Entity type:Organization
Organization Name:RIDGEVIEW RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-379-9237
Mailing Address - Street 1:1000 STATE ROUTE 70 STE 9
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5961
Mailing Address - Country:US
Mailing Address - Phone:909-379-9237
Mailing Address - Fax:888-507-7087
Practice Address - Street 1:1216 CLEVELAND WAY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-5906
Practice Address - Country:US
Practice Address - Phone:833-327-3268
Practice Address - Fax:888-507-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330021AP324500000X
CA330021BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330021APOtherBEHAVIORAL HEALTH TREATMENT FACILITY
CA330021BNOtherBEHAVIORAL HEALTH TREATMENT FACILITY