Provider Demographics
NPI:1891812327
Name:COMGRAPH INC.
Entity Type:Organization
Organization Name:COMGRAPH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, CRADC, NCC
Authorized Official - Phone:708-481-9570
Mailing Address - Street 1:252 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466
Mailing Address - Country:US
Mailing Address - Phone:708-481-9570
Mailing Address - Fax:708-481-9540
Practice Address - Street 1:252 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PARK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60466
Practice Address - Country:US
Practice Address - Phone:708-481-9570
Practice Address - Fax:708-481-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA10420001A261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA10420001AMedicaid