1841536992 NPI number — CHAMPAIGN URBANA NURSING AND REHAB LP

Table of content: (NPI 1841536992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841536992 NPI number — CHAMPAIGN URBANA NURSING AND REHAB LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAMPAIGN URBANA NURSING AND REHAB LP
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:
1841536992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8170 MCCORMICK BLVD
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-2961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-674-8200
Provider Business Mailing Address Fax Number:
814-674-4133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 BURWASH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVOY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61874-9572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-402-9700
Provider Business Practice Location Address Fax Number:
217-402-2209
Provider Enumeration Date:
12/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BAVER
Authorized Official First Name:
BARAK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-575-2222

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2075539 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0050062 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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