Provider Demographics
NPI:1316187446
Name:JOSEPH REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:JOSEPH REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ABIODUN
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PT
Authorized Official - Phone:708-420-3250
Mailing Address - Street 1:2 OLYMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4827
Mailing Address - Country:US
Mailing Address - Phone:708-420-3250
Mailing Address - Fax:708-429-5868
Practice Address - Street 1:2 OLYMPUS DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4827
Practice Address - Country:US
Practice Address - Phone:708-420-3250
Practice Address - Fax:708-429-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3104A0625X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness