Provider Demographics
NPI:1801935705
Name:ELMHURST REHABILITATION,S.C.
Entity type:Organization
Organization Name:ELMHURST REHABILITATION,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,PT,OCS
Authorized Official - Phone:630-350-2736
Mailing Address - Street 1:143 BERNICE DR
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3366
Mailing Address - Country:US
Mailing Address - Phone:630-350-2736
Mailing Address - Fax:630-350-2842
Practice Address - Street 1:143 BERNICE DR
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3366
Practice Address - Country:US
Practice Address - Phone:630-350-2736
Practice Address - Fax:630-350-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0712682225100000X
07125827225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL58850Medicare ID - Type Unspecified