Provider Demographics
NPI:1437359122
Name:OLD ORCHARD HEALTH MEDICAL AND REHAB CTR LTD
Entity Type:Organization
Organization Name:OLD ORCHARD HEALTH MEDICAL AND REHAB CTR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-677-9999
Mailing Address - Street 1:9933 LAWLER AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4302
Mailing Address - Country:US
Mailing Address - Phone:847-677-9999
Mailing Address - Fax:847-677-9955
Practice Address - Street 1:9933 LAWLER AVE STE 502
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4302
Practice Address - Country:US
Practice Address - Phone:847-677-9999
Practice Address - Fax:847-677-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12542OtherUPIN