1063799732 NPI number — NATIONAL REHABILITATION SERVICES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063799732 NPI number — NATIONAL REHABILITATION SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL REHABILITATION SERVICES PC
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:
1063799732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9127 FALCON RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60455-2608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-233-1232
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9515 INDIANAPOLIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 5A
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-233-1232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
IBRAHIM
Authorized Official First Name:
MHAMED
Authorized Official Middle Name:
SAEED
Authorized Official Title or Position:
RPT/ DIRECTOR
Authorized Official Telephone Number:
219-448-0667

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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