1871966382 NPI number — KIRBY REHABILITATION, INC

Table of content: (NPI 1871966382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871966382 NPI number — KIRBY REHABILITATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRBY REHABILITATION, INC
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:
KIRBY REHABILITATION
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:
1871966382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
723 W. 111TH ST
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:
60628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-614-4002
Provider Business Mailing Address Fax Number:
773-453-3262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
723 W. 111TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-614-4002
Provider Business Practice Location Address Fax Number:
773-453-3262
Provider Enumeration Date:
11/05/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIRBY
Authorized Official First Name:
LEA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-614-4002

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  CA8419-0001 , 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: CA8419-0001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".