Healthcare Provider Details

I. General information

NPI: 1821005844
Provider Name (Legal Business Name): RIDGEVIEW REHAB & NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 N RIDGE BLVD
CHICAGO IL
60626-4804
US

IV. Provider business mailing address

3737 W ARTHUR AVE
LINCOLNWOOD IL
60712-4029
US

V. Phone/Fax

Practice location:
  • Phone: 773-743-8700
  • Fax: 773-743-8407
Mailing address:
  • Phone: 847-679-2121
  • Fax: 847-679-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0009035
License Number StateIL

VIII. Authorized Official

Name: MR. JEFFREY WEBSTER
Title or Position: MANAGER
Credential:
Phone: 84767992121