Basic Information
| Provider Information | |||||||||
| NPI: | 1871057760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BURBANK REHABILITATION CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BURBANK REHABILITATION CENTER, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602021519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472612400 | ||||||||
| FaxNumber: | 8668409609 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 W 87TH ST | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604592913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084231200 | ||||||||
| FaxNumber: | 7084231266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2019 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROTHNER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANANGER | ||||||||
| AuthorizedOfficialTelephone: | 8472612400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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.