Basic Information
| Provider Information | |||||||||
| NPI: | 1073834958 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PF DEVELOPMENT 6 LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PEOPLEFIRST REHABILITATION OF ILLINOIS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4058 W MELROSE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606414799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737367000 | ||||||||
| FaxNumber: | 7732024355 | ||||||||
| Practice Location | |||||||||
| Address1: | 4058 W MELROSE ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606414799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737367000 | ||||||||
| FaxNumber: | 7732024355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2010 | ||||||||
| LastUpdateDate: | 11/30/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | ROTHGERBER | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5025967300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.