1710919063 NPI number — PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC

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 1710919063 NPI number — PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND 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:
Provider Other Organization Name Type Code:
6
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:
1710919063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BUTTERFIELD RD STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-296-2223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 MYRON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01089-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-526-9969
Provider Business Practice Location Address Fax Number:
413-526-9960
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
WADE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VP CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
630-296-2223

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251H1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 35264 . This is a "BMC-GROUP-DENDLOW" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 35265 . This is a "BMC GROUP ELM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA49027 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: OG0011 . This is a "BLUE CROSS OT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 043527 . This is a "CT CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 64-04290 . This is a "UNITED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9715568 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103355100 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4510980001 . This is a "DME" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 03527 . This is a "BMC GROUP ELM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 28117 . This is a "HNE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 690675 . This is a "TUFT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 972730 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y61264 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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