Provider Demographics
NPI:1134952443
Name:HUMBOLDT PARK HEALTH WELLNESS CENTER REHAB CLINIC
Entity type:Organization
Organization Name:HUMBOLDT PARK HEALTH WELLNESS CENTER REHAB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:CHERYL
Authorized Official - Last Name:ERINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-292-8200
Mailing Address - Street 1:1044 N FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2743
Mailing Address - Country:US
Mailing Address - Phone:773-292-8200
Mailing Address - Fax:
Practice Address - Street 1:2933 W. DIVISION
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:773-292-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMBOLDT PARK HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation