Basic Information
| Provider Information | |||||||||
| NPI: | 1629425491 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLOW RIDGE HEALTHCARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WILLOW RIDGE OF NC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 ROUTE 70 STE 3 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087017406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326591353 | ||||||||
| FaxNumber: | 8663060259 | ||||||||
| Practice Location | |||||||||
| Address1: | 237 TRYON RD | ||||||||
| Address2: | |||||||||
| City: | RUTHERFORDTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281393058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282867200 | ||||||||
| FaxNumber: | 8282873668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2016 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| AuthorizedOfficialLastName: | STERN | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7326591353 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.