1972532653 NPI number — SIMPLYREHAB, LLC

Table of content: (NPI 1972532653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972532653 NPI number — SIMPLYREHAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMPLYREHAB, LLC
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:
SIMPLYREHAB
Provider Other Organization Name Type Code:
3
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:
1972532653
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:
801 SKOKIE BLVD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-4039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-562-0800
Provider Business Mailing Address Fax Number:
847-562-0070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13820 UTICA AVE
Provider Second Line Business Practice Location Address:
THERPAY CLINIC
Provider Business Practice Location Address City Name:
ROBBINS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60472-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-293-0411
Provider Business Practice Location Address Fax Number:
708-293-0411
Provider Enumeration Date:
07/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROTH
Authorized Official First Name:
LIBBY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-562-0800

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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