NPI 1043548563

River District Rehabilitation, LLC

Organisation Point of Service Rockford, IL

Practice location

Address: 119 N Wyman St, Rockford, IL 61101-1107
Phone: (815) 977-4490
Fax: (815) 977-4594
Mailing address: 12402 Tweed Dr, Loves Park, IL 61111-8959

Authorised official

Name: Edwin Batifora Distrito
Title: Owner
Phone: (815) 885-2820

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence 1990943 (IL)

Other Point of Service providers in Illinois →

Registry record

NPI: 1043548563
Entity type: Organization
NPI issued: 20 Nov 2009
Record last updated: 20 Nov 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.