Provider Demographics
NPI:1538295332
Name:ALPHA REHABILITATION MEDICAL CENTER LTD
Entity Type:Organization
Organization Name:ALPHA REHABILITATION MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-788-3880
Mailing Address - Street 1:3253 HARLEM AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2996
Mailing Address - Country:US
Mailing Address - Phone:708-788-3880
Mailing Address - Fax:708-788-4757
Practice Address - Street 1:3253 HARLEM AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2996
Practice Address - Country:US
Practice Address - Phone:708-788-3880
Practice Address - Fax:708-788-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010456111NR0400X
IL038010321111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209391Medicare PIN