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WILLOW RIDGE ASSISTED LIVING LLC NPI 1215063441


NPI Information

NPI: 1215063441
Provider Name: WILLOW RIDGE ASSISTED LIVING LLC

Doing Business As: WILLOW RIDGE ASSISTED LIVING

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
2140 MILTON RD
CHARLOTTE, NC
ZIP 28215
Phone: (704) 563-7650
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WILLOW RIDGE ASSISTED LIVING LLC is an assisted living facility in Charlotte, NC. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. WILLOW RIDGE ASSISTED LIVING LLC NPI is 1215063441. The provider is registered as an organization entity type.
The provider Is Doing Business As Willow Ridge Assisted Living.

The provider's business location address is:

2140 MILTON RD
CHARLOTTE, NC
ZIP 28215-319
Phone: (704) 563-7650
Fax: (704) 535-6950

The provider's authorized official is Kenneth Hodges .
The authorized official title is Member Manager and has the following contact phone number (828) 738-3046.

The enumeration date for this NPI number is 2/23/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1310400000XAssisted Living FacilityHAL060070NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
17805586MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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