=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063929792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABCARE GROUP EAST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2018
-----------------------------------------------------
Last Update Date | 08/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ISLE AT WATERCREST DOMINION 6906 HEUERMANN ROAD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-947-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 COMPASS RD
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60026-8001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-441-5593
-----------------------------------------------------
Fax | 847-386-5196
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. ANNA GARDINA
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 847-441-5593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------