Organization
MAPLE RIDGE CARE CENTRE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CHARLES BRAUN (CONTROLLER)
(847) 583-0100
Entity
Organization
Contact information
Practice address
2202 N KICKAPOO ST, LINCOLN, IL 62656-1306
(217) 735-1538
(217) 732-4818
Mailing address
2202 N KICKAPOO ST, LINCOLN, IL 62656-1306
(217) 735-1538
(217) 732-4818
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
42366
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42366
IDPH LICENSE NUMBER
IL
01
—
6005490
IDPH FACILITY NUMBER
IL
Enumeration date
12/20/2005
Last updated
10/04/2011
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