Healthcare Provider Details

I. General information

NPI: 1508321936
Provider Name (Legal Business Name): PALOS HEIGHTS REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13259 S CENTRAL AVE
CRESTWOOD IL
60418-2901
US

IV. Provider business mailing address

2201 MAIN ST
EVANSTON IL
60202-1519
US

V. Phone/Fax

Practice location:
  • Phone: 708-597-1000
  • Fax: 708-239-6089
Mailing address:
  • Phone: 847-261-2420
  • Fax: 866-840-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ROTHNER
Title or Position: MANAGER
Credential:
Phone: 847-261-2400