=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326099128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABCARE GROUP EAST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 04/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3939 S 92ND ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-328-2091
-----------------------------------------------------
Fax | 414-546-1825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3939 S 92ND ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53228-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-328-2091
-----------------------------------------------------
Fax | 414-546-1825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT SECRETARY
-----------------------------------------------------
Name | MR. TERRANCE K. DILLON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-596-7220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------