Organization
COMGRAPH INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR THOMAS NEEDHAM JR. M.A., CRADC, NCC (DIRECTOR)
(708) 481-9570
Entity
Organization
Contact information
Practice address
252 MAIN STREET, PARK FOREST, IL 60466
(708) 481-9570
(708) 481-9540
Mailing address
252 MAIN STREET, PARK FOREST, IL 60466
(708) 481-9570
(708) 481-9540
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
A10420001A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A10420001A
—
IL
Enumeration date
03/22/2007
Last updated
08/22/2020
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