Basic Information
| Provider Information | |||||||||
| NPI: | 1740256155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWAY NEUROLOGICAL AND REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8540 S HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604551778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085982605 | ||||||||
| FaxNumber: | 7085985671 | ||||||||
| Practice Location | |||||||||
| Address1: | 8540 S HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604551778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085982605 | ||||||||
| FaxNumber: | 7085985671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 04/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | GUBIN | ||||||||
| AuthorizedOfficialFirstName: | MOISHE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2198983056 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 000047175 | IL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.