1598858839 NPI number — REHAB SERVICES ROOSEVELT, S.C.

Table of content: (NPI 1598858839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598858839 NPI number — REHAB SERVICES ROOSEVELT, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB SERVICES ROOSEVELT, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598858839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3553 W PETERSON AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60659-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-463-1313
Provider Business Mailing Address Fax Number:
773-463-5311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5420 W ROOSEVELT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60644-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-379-9999
Provider Business Practice Location Address Fax Number:
773-379-7113
Provider Enumeration Date:
09/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERGER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
773-519-0500

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)