1639554553 NPI number — ACCELERATED REHABILITATION CENTER OF KENOSHA LTD

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 1639554553 NPI number — ACCELERATED REHABILITATION CENTER OF KENOSHA LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCELERATED REHABILITATION CENTER OF KENOSHA LTD
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:
1639554553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2998 MOMENTUM PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60689-5330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-657-0222
Provider Business Mailing Address Fax Number:
262-657-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARENGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60152-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-568-4550
Provider Business Practice Location Address Fax Number:
815-568-5071
Provider Enumeration Date:
07/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
EXNER
Authorized Official First Name:
TASYA
Authorized Official Middle Name:
Authorized Official Title or Position:
UPFRONT SYSTEM DIRECTOR
Authorized Official Telephone Number:
262-657-0222

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)





Copyright © 2007-2025 www.npivalidator.com