Healthcare Provider Details

I. General information

NPI: 1740898774
Provider Name (Legal Business Name): NORTH STAR REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 MILL ST
BATAVIA IL
60510-9251
US

IV. Provider business mailing address

366 MILL ST
BATAVIA IL
60510-9251
US

V. Phone/Fax

Practice location:
  • Phone: 630-220-0611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY HAYES
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 630-220-0611