1760544951 NPI number — NEWSOME REHABILITATION CENTER

Table of content: (NPI 1760544951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760544951 NPI number — NEWSOME REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWSOME REHABILITATION CENTER
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:
NEWSOME PHYSICAL THERAPY NETWORK
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:
1760544951
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:
920 ESSINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-2859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-744-4770
Provider Business Mailing Address Fax Number:
815-744-1845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25445 S PHEASANT LN
Provider Second Line Business Practice Location Address:
UNIT H
Provider Business Practice Location Address City Name:
CHANNAHON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60410-8838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-521-0111
Provider Business Practice Location Address Fax Number:
815-521-0222
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HATZL
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BILLING COLLECTIONS SUPERVISOR
Authorized Official Telephone Number:
815-744-4770

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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)





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