Healthcare Provider Details

I. General information

NPI: 1063479160
Provider Name (Legal Business Name): REGAL HEALTH AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 MAYFIELD AVE
OAK LAWN IL
60453-2817
US

IV. Provider business mailing address

9525 MAYFIELD AVE
OAK LAWN IL
60453-2817
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-7000
  • Fax: 708-422-3520
Mailing address:
  • Phone: 708-636-7000
  • Fax: 708-422-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0038091
License Number StateIL

VIII. Authorized Official

Name: MR. EARL E VAN DUSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 708-636-7000