Provider Demographics
NPI:1639290455
Name:REBELS WITH A CAUSE
Entity Type:Organization
Organization Name:REBELS WITH A CAUSE
Other - Org Name:HOMEWATCH CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-459-1502
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60039-0249
Mailing Address - Country:US
Mailing Address - Phone:815-459-1502
Mailing Address - Fax:815-425-1058
Practice Address - Street 1:333 COMMERCE DR
Practice Address - Street 2:STE 275
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3539
Practice Address - Country:US
Practice Address - Phone:815-459-1502
Practice Address - Fax:815-425-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty