Provider Demographics
NPI:1073670444
Name:REHABILITATION INSTITUTE OF CHICAGO
Entity Type:Organization
Organization Name:REHABILITATION INSTITUTE OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FASEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS, CSCS
Authorized Official - Phone:312-238-7737
Mailing Address - Street 1:345 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2654
Mailing Address - Country:US
Mailing Address - Phone:312-238-7767
Mailing Address - Fax:
Practice Address - Street 1:1030 N CLARK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5467
Practice Address - Country:US
Practice Address - Phone:312-238-7767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital