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General NPI Number Information
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NPI Number | 1861942435
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Entity Type | Organization
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Legal Business Name | RIDGEVIEW CARE CENTER LLC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 413 RIDGE LN
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City | OBLONG
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State | IL
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Zip | 62449-1635
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Country | US
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Telephone | 618-592-4228
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Fax | 618-592-3026
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Provider Business Mailing Address
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Address Line | 413 RIDGE LN
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City | OBLONG
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State | IL
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Zip | 62449-1635
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Country | US
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Telephone | 618-592-4228
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Fax | 618-592-3026
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SARAH GRIESEMER
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Credential | LNHA, MHA
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Telephone | 618-592-4228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0051912
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License Number State | IL
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