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General NPI Number Information
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NPI Number | 1801194527
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Entity Type | Organization
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Legal Business Name | SUBURBAN HEALTH AND REHABILITATION CENTER
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 112 S HALSTED ST
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-1256
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Country | US
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Telephone | 708-756-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 112 S HALSTED ST
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-1256
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KEITH GILL
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Credential |
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Telephone | 708-756-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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