Basic Information
| Provider Information | |||||||||
| NPI: | 1932218773 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY REHAB LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962222 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 SAPP BROTHERS DR | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681383823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024084281 | ||||||||
| FaxNumber: | 4027398964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 03/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | MCGIVERN | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6302962222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 83270 | 01 | NE | COVENTRY GROUP | OTHER | 6400159 | 05 | NE | MEDICAID | 01805 | 01 | NE | BLUE CROSS BLUE SHIELD | OTHER | 0586339 | 05 | IA | MEDICAID | 193153203 | 01 | NE | DOL- OWCP | OTHER | S561 | 01 | NE | MIDLANDS CHOICE | OTHER |