Provider Demographics
NPI:1427131697
Name:MARIANJOY REHABILITATION HOSPITAL
Entity type:Organization
Organization Name:MARIANJOY REHABILITATION HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-531-0099
Mailing Address - Street 1:2245 ENTERPRISE DR
Mailing Address - Street 2:SUITE 4514
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5813
Mailing Address - Country:US
Mailing Address - Phone:708-531-0099
Mailing Address - Fax:708-531-1909
Practice Address - Street 1:2245 ENTERPRISE DR
Practice Address - Street 2:SUITE 4514
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5813
Practice Address - Country:US
Practice Address - Phone:708-531-0099
Practice Address - Fax:708-531-1909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIANJOY REHABILITATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007OtherBLUE CROSS BLUE SHIELD
IL146661Medicare Oscar/Certification
IL0007OtherBLUE CROSS BLUE SHIELD
IN156621Medicare Oscar/Certification