Provider Demographics
NPI:1861942435
Name:RIDGEVIEW CARE CENTER LLC
Entity type:Organization
Organization Name:RIDGEVIEW CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIESEMER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA, MHA
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 RIDGE 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:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0051912332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801Medicaid
IL=========801Medicaid