Basic Information
| Provider Information | |||||||||
| NPI: | 1598301806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIDGES AT PEORIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 HAZELTINE BLVD, BOX 36 | ||||||||
| Address2: | |||||||||
| City: | CHASKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553181009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523618935 | ||||||||
| FaxNumber: | 9523618060 | ||||||||
| Practice Location | |||||||||
| Address1: | 18170 N 91ST AVE | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853820866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239745848 | ||||||||
| FaxNumber: | 6239743831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2019 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | WEICHERT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | BOARD MEMBERR | ||||||||
| AuthorizedOfficialTelephone: | 6126181682 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.