Provider Demographics
NPI:1215473673
Name:REBOUND HEALTHCARE SYSTEMS LLC
Entity type:Organization
Organization Name:REBOUND HEALTHCARE SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-210-2476
Mailing Address - Street 1:435 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5006
Mailing Address - Country:US
Mailing Address - Phone:217-210-2476
Mailing Address - Fax:217-210-2549
Practice Address - Street 1:435 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5006
Practice Address - Country:US
Practice Address - Phone:217-210-2476
Practice Address - Fax:217-210-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-63130001-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-63130001-AOtherILLINOIS DEPARTMENT OF HUMAN SERVICES, DASA