Provider Demographics
NPI:1598262057
Name:ADVANCE CARE AND REHAB
Entity Type:Organization
Organization Name:ADVANCE CARE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:MANNAN
Authorized Official - Last Name:SHAMSUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:224-595-1631
Mailing Address - Street 1:2555 SUFFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4831
Mailing Address - Country:US
Mailing Address - Phone:224-595-1631
Mailing Address - Fax:
Practice Address - Street 1:2555 SUFFIELD ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4831
Practice Address - Country:US
Practice Address - Phone:224-595-1631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619494838Medicaid