Organization
RIVER DISTRICT REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWIN BATIFORA DISTRITO (OWNER)
(815) 885-2820
Entity
Organization
Contact information
Practice address
119 N WYMAN ST, ROCKFORD, IL 61101-1107
(815) 977-4490
(815) 977-4594
Mailing address
12402 TWEED DR, LOVES PARK, IL 61111-8959
(815) 885-2820
(815) 977-4594
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
1990943
IL
Other
Enumeration date
11/20/2009
Last updated
11/20/2009
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