Basic Information
| Provider Information | |||||||||
| NPI: | 1508321936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALOS HEIGHTS REHABILITATION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602021519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472612420 | ||||||||
| FaxNumber: | 8668409609 | ||||||||
| Practice Location | |||||||||
| Address1: | 13259 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | CRESTWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604182901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085971000 | ||||||||
| FaxNumber: | 7082396089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2019 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | ROTHNER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8472612400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.