Provider Demographics
NPI:1326245499
Name:I. J. REHAB. INC.
Entity Type:Organization
Organization Name:I. J. REHAB. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORILISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:773-521-5300
Mailing Address - Street 1:3004 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4458
Mailing Address - Country:US
Mailing Address - Phone:773-521-5300
Mailing Address - Fax:773-521-5305
Practice Address - Street 1:3004 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4458
Practice Address - Country:US
Practice Address - Phone:773-521-5300
Practice Address - Fax:773-521-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL348683850001Medicaid
IL348683850001Medicaid