Basic Information
| Provider Information | |||||||||
| NPI: | 1619563269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIDLEY | ||||||||
| FirstName: | CHAMPAGNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 E HORIZON RIDGE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890027936 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 E HORIZON RIDGE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890027936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026443600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2020 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | NV | Y | Nursing Service Related Providers | Technician | Personal Care Attendant | 372500000X | NV | N | Nursing Service Related Providers | Chore Provider | 372600000X | NV | N | Nursing Service Related Providers | Adult Companion | 3747A0650X | NV | N | Nursing Service Related Providers | Technician | Attendant Care Provider | 376J00000X | NV | N | Nursing Service Related Providers | Homemaker |
No ID Information.