Provider Demographics
NPI:1023023579
Name:REHAB INNOVATIONS LLC
Entity Type:Organization
Organization Name:REHAB INNOVATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC, PTA
Authorized Official - Phone:618-549-9449
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-0055
Mailing Address - Country:US
Mailing Address - Phone:618-549-9449
Mailing Address - Fax:
Practice Address - Street 1:200 N EMERALD LN
Practice Address - Street 2:SUITE 1A
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2100
Practice Address - Country:US
Practice Address - Phone:618-549-9449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL473850OtherHEALTH LINK PROVIDER NUMB
IL100174OtherHEALTH ALLIANCE PROVIDER
IL03927511OtherBCBS PROVIDER NUMBER
IL03927511OtherBCBS PROVIDER NUMBER