Provider Demographics
NPI:1053404640
Name:COMMUNITY HEALTH & REHABILITATION, SC
Entity type:Organization
Organization Name:COMMUNITY HEALTH & REHABILITATION, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-885-8820
Mailing Address - Street 1:275 W HIGGINS ROAD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169
Mailing Address - Country:US
Mailing Address - Phone:847-885-8820
Mailing Address - Fax:847-885-9578
Practice Address - Street 1:275 W HIGGINS ROAD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-885-8820
Practice Address - Fax:847-885-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617415111NX0800X
IL036-103275207Q00000X
IL1679510804208D00000X
IL332BX2000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1621687OtherBLUE CROSS BLUE SHIELD
IL7761619001OtherCIGNA
IL1621687OtherBLUE CROSS BLUE SHIELD
IL212818Medicare PIN