RIVER RIDGE LLC NPI 1295105906

NPI Information

RIVER RIDGE, LLC is a rehabilitation and substance use disorder clinic center in Plymouth, MN. RIVER RIDGE, LLC NPI is 1295105906. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As River Ridge Llc Four Seasons Outpatient.

The provider's business location address is:

4205 LANCASTER LN N STE 101
PLYMOUTH, MN
ZIP 55441-702
Phone: (952) 894-7722
Fax: (952) 894-0882

The provider's authorized official is Patricia Patche .
The authorized official title is Cfo and has the following contact phone number (952) 564-3000.

The CLIA number assigned to this NPI record is 24D0907487 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/7/2015 and was last updated on 7/19/2022.

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:

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