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RIDGEWOOD MANOR
NPI 1407280720
Custodial Care Facility - Adult Care Home in Elk River, MN

Active since August 22, 2013CLIA 24D2124625 · Waiver
10038 215TH AVE NW, ELK RIVER, MN 55330(763) 607-6874(267) 350-9164 Get Directions Write a Review

NPPES record last updated: August 22, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Ridgewood Manor NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RIDGEWOOD MANOR (NPI 1407280720) is a healthcare organization registered as an adult care home in Elk River, Minnesota and active in the NPI registry since August 2013. The organization holds a CLIA Waiver certificate valid through January 22, 2027 and lists Gregory M Petersen, Partner, as its authorized official.

NPPES Registry Identity

NPI1407280720
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameRIDGEWOOD MANOR
Location Address10038 215TH AVE NWElk River, MN 55330-8519
Mailing Address10038 215th Ave NwElk River, MN 55330-8519 · (763) 607-6874 · Fax (267) 350-9164
Phone(763) 607-6874
Fax(267) 350-9164
Organization SubpartNo
Authorized OfficialGregory M PetersenPartner · (763) 607-6874
Enumeration DateAugust 22, 2013
✔ NPI 1407280720 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
License✔ Licensed in MN · 1066808-1-AFC
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
10038 215TH AVE NW, Elk River, MN 55330
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2124625

Ridgewood Manor (hcp) Oak House (hws) · Elk River, MN
Active · expires Jan 22, 2027
CLIA Number24D2124625
Laboratory TypeComprehensive Home Care H
Certificate Effective DateJanuary 23, 2025
Certificate Expiration DateJanuary 22, 2027
Laboratory DirectorMelissa K. Koop
Laboratory Phone(320) 336-9835
Laboratory LocationRidgewood Manor (hcp) Oak House (hws)10038 215th Ave NW, Elk River, MN 55330
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ridgewood Manor's NPI number?

The NPI number for Ridgewood Manor is 1407280720. It was assigned to this organization in the NPPES registry on August 22, 2013.

Where is Ridgewood Manor located?

Ridgewood Manor is located at 10038 215th Ave NW, Elk River, MN 55330. The listed phone number is (763) 607-6874.

What is Ridgewood Manor's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Does Ridgewood Manor hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2124625) is associated with this NPI, valid through January 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ridgewood Manor was last updated on August 22, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.