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NPI Code Detail

MEDICARE: WORK HARDENING OF WEST LOOP

MEDICARE: WORK HARDENING OF WEST LOOP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0400XRehabilitation Clinic/Center66437582IL

General Provider Information

NPI Number : 1932361623
Entity Type Code : Organization
Provider Name (Legal Business Name) : WORK HARDENING OF WEST LOOP
Provider Business Mailing Address
First Line : 5252 N WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2448
Country : US
Telephone Number : 773-878-7909
Fax Number : 773-878-4763
Provider Business Practice Location Address
First Line : 601 W RANDOLPH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60661-2232
Country : US
Telephone Number : 312-798-7246
Fax Number : 312-798-7247
Authorized Official
Title or Position : PRESIDENT
Name : ROBERTO DIAZ
Credential :
Telephone Number : 773-878-7909
Provider Enumeration Date : 06/25/2008
Last Update Date : 06/25/2008

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Directions to “WORK HARDENING OF WEST LOOP ” Practice Location

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