Provider Demographics
NPI:1467647883
Name:ILLINOIS CENTER FOR REHABILITATION AND EDUCATION
Entity Type:Organization
Organization Name:ILLINOIS CENTER FOR REHABILITATION AND EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-433-3121
Mailing Address - Street 1:400 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2625
Mailing Address - Country:US
Mailing Address - Phone:217-524-4089
Mailing Address - Fax:217-524-2352
Practice Address - Street 1:1950 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1245
Practice Address - Country:US
Practice Address - Phone:312-433-3110
Practice Address - Fax:312-433-3180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376002057003Medicaid