Organization
GREAT LAKES REHABILITATION SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK CHODZEN (PRESIDENT)
(773) 745-0301
Entity
Organization
Contact information
Practice address
2651 N LARAMIE AVE, CHICAGO, IL 60639-1613
(773) 745-0301
(773) 745-3506
Mailing address
2641 N LARAMIE AVE, CHICAGO, IL 60639-1644
(773) 745-0301
(773) 745-3506
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.001473
IL
Other
Enumeration date
04/12/2013
Last updated
04/12/2013
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