Provider Demographics
NPI:1629044565
Name:PREMIER REHAB SERVICES LLC
Entity Type:Organization
Organization Name:PREMIER REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRITESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:847-952-9040
Mailing Address - Street 1:660 E GOLF RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4061
Mailing Address - Country:US
Mailing Address - Phone:847-952-9040
Mailing Address - Fax:847-952-9050
Practice Address - Street 1:660 E GOLF RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4061
Practice Address - Country:US
Practice Address - Phone:847-952-9040
Practice Address - Fax:847-952-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212897Medicare ID - Type Unspecified
ILY48945Medicare UPIN