Provider Demographics
NPI:1326099128
Name:REHABCARE GROUP EAST, LLC
Entity Type:Organization
Organization Name:REHABCARE GROUP EAST, LLC
Other - Org Name:REHABCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:3939 S 92ND ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2140
Mailing Address - Country:US
Mailing Address - Phone:414-328-2091
Mailing Address - Fax:414-546-1825
Practice Address - Street 1:3939 S 92ND ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228
Practice Address - Country:US
Practice Address - Phone:414-328-2091
Practice Address - Fax:414-546-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41814900Medicaid
WI41814900Medicaid