Provider Demographics
NPI:1639364979
Name:CAREMARK REHAB, LTD.
Entity Type:Organization
Organization Name:CAREMARK REHAB, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEVERENZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:563-343-4735
Mailing Address - Street 1:2834 N 2200TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:IL
Mailing Address - Zip Code:62324-2312
Mailing Address - Country:US
Mailing Address - Phone:563-343-4735
Mailing Address - Fax:
Practice Address - Street 1:101 PRAIRIE MILLS RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:IL
Practice Address - Zip Code:62339-1016
Practice Address - Country:US
Practice Address - Phone:217-696-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty