=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871977751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2015
-----------------------------------------------------
Last Update Date | 06/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3249 OAK PARK AVE 22 NORTH
-----------------------------------------------------
City | BERWYN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-783-3456
-----------------------------------------------------
Fax | 708-783-2167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3249 OAK PARK AVE
-----------------------------------------------------
City | BERWYN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60402-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-216-0378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR BILLING OPERATIONS
-----------------------------------------------------
Name | ADENRELE KOLAWOLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-216-3743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------