Provider Demographics
NPI:1821284829
Name:NEWSOME REHABILITATION CENTER
Entity Type:Organization
Organization Name:NEWSOME REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND COLLECTIONS SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATZL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-744-4770
Mailing Address - Street 1:450 N KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2900
Mailing Address - Country:US
Mailing Address - Phone:815-932-7787
Mailing Address - Fax:815-932-7895
Practice Address - Street 1:450 N KENNEDY DR
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2900
Practice Address - Country:US
Practice Address - Phone:815-932-7787
Practice Address - Fax:815-932-7895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWSOME PHYSICAL THERAPY NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14663601Medicare Oscar/Certification