Healthcare Provider Details

I. General information

NPI: 1861942435
Provider Name (Legal Business Name): RIDGEVIEW CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 RIDGE LN
OBLONG IL
62449-1635
US

IV. Provider business mailing address

413 RIDGE LN
OBLONG IL
62449-1635
US

V. Phone/Fax

Practice location:
  • Phone: 618-592-4228
  • Fax: 618-592-3026
Mailing address:
  • Phone: 618-592-4228
  • Fax: 618-592-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0051912
License Number StateIL

VIII. Authorized Official

Name: SARAH GRIESEMER
Title or Position: ADMINISTRATOR
Credential: LNHA, MHA
Phone: 618-592-4228