Provider Demographics
NPI:1992337869
Name:RIDGELINE SERVICES
Entity type:Organization
Organization Name:RIDGELINE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZORNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-687-2445
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-0184
Mailing Address - Country:US
Mailing Address - Phone:304-745-7837
Mailing Address - Fax:360-242-5842
Practice Address - Street 1:2162 CHILDRESS ROAD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003
Practice Address - Country:US
Practice Address - Phone:304-745-7837
Practice Address - Fax:360-242-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty