Provider Demographics
NPI:1205879095
Name:REHABILITATION INSTITUTE OF CHICAGO
Entity type:Organization
Organization Name:REHABILITATION INSTITUTE OF CHICAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:312-238-1000
Mailing Address - Street 1:355 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3167
Mailing Address - Country:US
Mailing Address - Phone:312-238-4270
Mailing Address - Fax:312-238-7569
Practice Address - Street 1:355 E ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3167
Practice Address - Country:US
Practice Address - Phone:312-238-4270
Practice Address - Fax:312-238-7569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL354OtherBLUE CROSS
IL=========001Medicaid
IL354OtherBLUE CROSS
IL806510Medicare PIN
IL806500Medicare PIN
IL=========001Medicaid
IL201923Medicare PIN
IL354OtherBLUE CROSS
IL573230Medicare PIN