Provider Demographics
NPI:1740345818
Name:PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC
Entity type:Organization
Organization Name:PERFORMANCE REHABILITATION OF WESTERN NEW ENGLAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-2222
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:168 DENSLOW RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-3188
Practice Address - Country:US
Practice Address - Phone:413-526-9969
Practice Address - Fax:413-526-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 2251H1200X, 225X00000X, 225XH1200X
MA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35265OtherBIRNIE BMC GROUP
MAOG0011OtherBLUE CROSS
MAY61264OtherBLUE CROSS PT
MA690675OtherTUFTS GROUP
MA972730OtherNETWORK HEALTH GROUP
MA64-04290OtherUNITED GROUP
MA9715568OtherMASS HEALTH GROUP
MA03527OtherBMC ELM GROUP
MA103355100OtherDOL GROUP
MA28117OtherHNE GROUP
MA9715568Medicaid
MAAA49027OtherHARVARD PILGRIM
MA043527OtherCT CARE GROUP
MA35264OtherDENSLOW BMC GROUP
MAPT0191OtherMEDICARE
MAY61264OtherBLUE CROSS PT
MA03527OtherBMC ELM GROUP
MA9715568OtherMASS HEALTH GROUP
MA03527OtherBMC ELM GROUP
MAPT0191Medicare PIN