Basic Information
| Provider Information | |||||||||
| NPI: | 1003849506 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MINERAL RIDGE SKILLED NURSING AND RESIDENTIAL CARE, LLC | ||||||||
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| OtherOrganizationName: | CONTINUING HEALTHCARE AT THE RIDGE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7261 ENGLE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441308467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167721105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3379 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MINERAL RIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444409735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306529901 | ||||||||
| FaxNumber: | 3305447541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PARSONS | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 2167721105 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 1218R | OH | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 314000000X | 1218N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2658271 | 05 | OH | MEDICAID | 167615174 | 01 | OH | MEDICAID ASSISTANT LIVING WAIVER | OTHER |