Provider Demographics
NPI:1104042993
Name:LIVING CENTERS INC
Entity Type:Organization
Organization Name:LIVING CENTERS INC
Other - Org Name:ICG REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:217-422-7150
Mailing Address - Street 1:180 W IMBODEN DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-5238
Mailing Address - Country:US
Mailing Address - Phone:217-422-7150
Mailing Address - Fax:217-422-9418
Practice Address - Street 1:185 W IMBODEN DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5251
Practice Address - Country:US
Practice Address - Phone:217-233-1425
Practice Address - Fax:217-233-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146716Medicare Oscar/Certification