Provider Demographics
NPI:1952308447
Name:JOSEPH C CUNNINGHAM
Entity Type:Organization
Organization Name:JOSEPH C CUNNINGHAM
Other - Org Name:RIDGEVIEW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GRIESEMER
Authorized Official - Suffix:
Authorized Official - Credentials:
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 RIDGEVIEW 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:2005-06-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000026021314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL146096Medicare ID - Type Unspecified