Provider Demographics
NPI:1689020844
Name:WOODRIDGE NORTHWEST, LLC
Entity type:Organization
Organization Name:WOODRIDGE NORTHWEST, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-554-7903
Mailing Address - Street 1:2520 NORTHWINDS PKWY STE 550
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2236
Mailing Address - Country:US
Mailing Address - Phone:470-554-7903
Mailing Address - Fax:
Practice Address - Street 1:2466 S 48TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6683
Practice Address - Country:US
Practice Address - Phone:615-860-9230
Practice Address - Fax:615-860-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR237323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR218443125Medicaid