Healthcare Provider Details

I. General information

NPI: 1871619940
Provider Name (Legal Business Name): RIDGELAND NURSING AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 S RIDGELAND AVE
PALOS HEIGHTS IL
60463-1859
US

IV. Provider business mailing address

12550 S RIDGELAND AVE
PALOS HEIGHTS IL
60463-1859
US

V. Phone/Fax

Practice location:
  • Phone: 708-597-9300
  • Fax: 708-597-0038
Mailing address:
  • Phone: 708-597-9300
  • Fax: 708-597-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0046193
License Number StateIL

VIII. Authorized Official

Name: MR. MARK STEINBERG
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 847-905-3000