Provider Demographics
NPI:1487083010
Name:THE RIDGE REHABILITATION AND HEALTHCARE CENTER, LLC
Entity type:Organization
Organization Name:THE RIDGE REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:226 WA REEL DR
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-4534
Mailing Address - Country:US
Mailing Address - Phone:803-637-5312
Mailing Address - Fax:803-637-0059
Practice Address - Street 1:226 WA REEL DR
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4534
Practice Address - Country:US
Practice Address - Phone:803-637-5312
Practice Address - Fax:803-637-0059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORIANNA SC OPERATOR HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-04
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNF1043Medicaid
SCNF1043Medicaid