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Organization

INNOVATIVE OUTPATIENT MEDICAL SYSTEMS

Active
Other names
Innovative Care Therapy Center
Organization subpart
No

Provider details

NPI number
Authorized official
PHILIP DEJONG (VICE PRESIDENT)
(708) 532-1337
Entity
Organization

Contact information

Practice address
18425 WEST CREEK DRIVE, SUITE G, TINLEY PARK, IL 60477-6767
(708) 532-1337
(708) 532-1899
Mailing address
18425 WEST CREEK DRIVE, SUITE G, TINLEY PARK, IL 60477-6767
(708) 532-1337
(708) 532-1899

Taxonomy

Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
9932192
BCBS
IL
Enumeration date
10/02/2006
Last updated
08/22/2020
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