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General NPI Number Information
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NPI Number | 1831580075
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Entity Type | Organization
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Legal Business Name | AVANZA REHABILITATION LTD
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 3501 E 106TH ST STE 102
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City | CHICAGO
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State | IL
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Zip | 60617-6625
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Country | US
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Telephone | 773-503-8715
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 E 106TH ST SUITE 102
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City | CHICAGO
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State | IL
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Zip | 60617-6625
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Country | US
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Telephone | 773-503-8715
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/PRESIDENT
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Name | ALEXANDER ALVAREZ
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Credential | M.S. OTR/L
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Telephone | 773-503-8715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 04928725
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License Number State | IL
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