Provider Demographics
NPI:1003435934
Name:THE TABOR THERAPY GROUP, INC
Entity Type:Organization
Organization Name:THE TABOR THERAPY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-331-8768
Mailing Address - Street 1:5404 W ELM ST STE H
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4007
Mailing Address - Country:US
Mailing Address - Phone:815-331-8768
Mailing Address - Fax:
Practice Address - Street 1:12151 REGENCY PKWY STE 12169
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7644
Practice Address - Country:US
Practice Address - Phone:815-331-8768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE TABOR THERAPY GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2B17-IPI-002Medicaid