Basic Information
| Provider Information | |||||||||
| NPI: | 1275208894 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINERAL RIDGE SKILLED NURSING AND RESIDENTIAL CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5990 VENTURE DR STE A | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430172273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167721105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3379 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MINERAL RIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444408800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306529901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2021 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | PARSONS | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2167721105 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MINERAL RIDGE SKILLED NURSING AND RESIDENTIAL CARE, LLC | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343900000X | Y | Transportation Services | Non-emergency Medical Transport (VAN) |
No ID Information.