Provider Demographics
NPI:1477653780
Name:ADVOCATE REHAB CLINIC, INC.
Entity Type:Organization
Organization Name:ADVOCATE REHAB CLINIC, INC.
Other - Org Name:ACTIVE PHYSICAL THERAPY & PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:708-715-1122
Mailing Address - Street 1:5009 W 95TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2401
Mailing Address - Country:US
Mailing Address - Phone:708-715-1122
Mailing Address - Fax:708-499-9466
Practice Address - Street 1:5009 W 95TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2401
Practice Address - Country:US
Practice Address - Phone:708-499-2622
Practice Address - Fax:708-499-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001635584OtherBCBS PROV NO
IL338865784Medicaid
IL338865784Medicaid
IL338865784Medicaid