Provider Demographics
NPI:1457332249
Name:RIDGEWOOD HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:RIDGEWOOD HEALTHCARE CENTER, LLC
Other - Org Name:RIDGEWOOD HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:NEELE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-720-8720
Mailing Address - Street 1:6400 SHAFER CT
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4914
Mailing Address - Country:US
Mailing Address - Phone:847-720-8722
Mailing Address - Fax:847-720-8701
Practice Address - Street 1:3558 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3122
Practice Address - Country:US
Practice Address - Phone:330-666-3776
Practice Address - Fax:330-665-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304910Medicaid
365296Medicare ID - Type UnspecifiedMEDICARE PROVIDOR