Provider Demographics
NPI:1396002762
Name:RIDGEVIEW CARE CENTER
Entity Type:Organization
Organization Name:RIDGEVIEW CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GRIESEMER
Authorized Official - Suffix:
Authorized Official - Credentials:MHA/LNHA
Authorized Official - Phone:618-592-4228
Mailing Address - Street 1:413 RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:OBLONG
Mailing Address - State:IL
Mailing Address - Zip Code:62449-1635
Mailing Address - Country:US
Mailing Address - Phone:618-592-4228
Mailing Address - Fax:618-592-3026
Practice Address - Street 1:413 RIDGE LN
Practice Address - Street 2:
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-1635
Practice Address - Country:US
Practice Address - Phone:618-592-4228
Practice Address - Fax:618-592-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0026021314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370842650Medicaid
IL370842650Medicaid