| NPI | 1427774918 |
|---|---|
| Doing Business As | LAKE RIDGE CENTER |
| Entity Type | Organization |
| Authorized Contact | MICHAEL T BERG Asst Secretary 505-468-4742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2022-10-17 |