Basic Information
| Provider Information | |||||||||
| NPI: | 1821005844 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIDGEVIEW REHAB & NURSING CENTER, LLC | ||||||||
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| OtherOrganizationName: | RIDGEVIEW REHAB & NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 W ARTHUR AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607124029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476792121 | ||||||||
| FaxNumber: | 8476792122 | ||||||||
| Practice Location | |||||||||
| Address1: | 6450 N RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606264804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737438700 | ||||||||
| FaxNumber: | 7737438407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 12/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEBSTER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 84767992121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0009035 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0048470 | 05 | IL | MEDICAID |