Provider Demographics
NPI:1720401193
Name:COVENANT ALLIANCE REHAB
Entity Type:Organization
Organization Name:COVENANT ALLIANCE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-413-5820
Mailing Address - Street 1:1520 KENSINGTON RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2139
Mailing Address - Country:US
Mailing Address - Phone:630-413-5800
Mailing Address - Fax:630-413-5801
Practice Address - Street 1:1520 KENSINGTON RD
Practice Address - Street 2:SUITE 110
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2139
Practice Address - Country:US
Practice Address - Phone:630-413-5800
Practice Address - Fax:630-413-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2279G0305XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeriatric CareGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10414859OtherSTATE LICENSE NUMBER