Provider Demographics
NPI:1982719746
Name:SELECT REHABILITATION, LLC
Entity Type:Organization
Organization Name:SELECT REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-441-5593
Mailing Address - Street 1:2600 COMPASS RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8001
Mailing Address - Country:US
Mailing Address - Phone:847-441-5593
Mailing Address - Fax:847-386-5196
Practice Address - Street 1:1000 TWINRIDGE LN
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5248
Practice Address - Country:US
Practice Address - Phone:804-320-5629
Practice Address - Fax:434-792-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4978200Medicaid
VA496526Medicare ID - Type UnspecifiedMEDICARE