Provider Demographics
NPI:1932260676
Name:RUSH OAK PARK HOSPITAL
Entity Type:Organization
Organization Name:RUSH OAK PARK HOSPITAL
Other - Org Name:RUSH OAK PARK HOSPITAL REHABILITATION UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELEGANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-660-6662
Mailing Address - Street 1:520 SOUTH MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1097
Mailing Address - Country:US
Mailing Address - Phone:708-646-6633
Mailing Address - Fax:708-660-6658
Practice Address - Street 1:520 SOUTH MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304
Practice Address - Country:US
Practice Address - Phone:708-660-2800
Practice Address - Fax:708-660-3714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH OAK PARK HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1744986273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid