Provider Demographics
NPI:1295781557
Name:THE ADULT AND CHILD REHAB CENTER FOR MCHENRY COUNTY, INC.
Entity type:Organization
Organization Name:THE ADULT AND CHILD REHAB CENTER FOR MCHENRY COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-338-1707
Mailing Address - Street 1:708 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-2265
Mailing Address - Country:US
Mailing Address - Phone:815-338-1707
Mailing Address - Fax:815-338-1786
Practice Address - Street 1:708 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-2265
Practice Address - Country:US
Practice Address - Phone:815-338-1707
Practice Address - Fax:815-338-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
IL1747736251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5014OtherBLUE CROSS BLUE SHIELD
IL5014OtherBLUE CROSS BLUE SHIELD
IL147296Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER