Provider Demographics
NPI:1508321936
Name:PALOS HEIGHTS REHABILITATION LLC
Entity Type:Organization
Organization Name:PALOS HEIGHTS REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-261-2400
Mailing Address - Street 1:2201 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1519
Mailing Address - Country:US
Mailing Address - Phone:847-261-2420
Mailing Address - Fax:866-840-9609
Practice Address - Street 1:13259 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-2901
Practice Address - Country:US
Practice Address - Phone:708-597-1000
Practice Address - Fax:708-239-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility