Presbyterian Homes Outpatient Rehabilitation Agency LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

PRESBYTERIAN HOMES OUTPATIENT REHABILITATION AGENCY LLC

Practice address

3200 Grant St
Evanston, IL 60201-1903

Phone

(847) 492-2940

Fax

(847) 492-2850

NPI assigned

Nov 28, 2014

Organization subpart

Yes

Parent organization

PRESBYTERIAN HOMES MANAGER LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Havrilka

Title

Chief Financial Officer

Phone

(847) 979-3904

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 146749

Legal name

PRESBYTERIAN HOMES OUTPATIENT REHABILITATION AGENC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jan 15, 2016

Last certification

Jan 15, 2016

Ownership / control type

Voluntary Non-Profit Other Than Church

Facility address

3200 Grant St
Evanston, IL 60201

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Westminster Place

  • Skilled Nursing Facility
  • Evanston, IL
  • NPI 1750351425

  Other

  CMS ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1306243852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8707 SKOKIE BLVD STE 400",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600772283",
            "telephone_number": "847-979-3955",
            "fax_number": "847-979-3969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 GRANT ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011903",
            "telephone_number": "847-492-2940",
            "fax_number": "847-492-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOMES OUTPATIENT REHABILITATION AGENCY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESBYTERIAN HOMES MANAGER LLC",
        "enumeration_date": "2014-11-28",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "HAVRILKA",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "847-979-3904"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Prendergast, MD
• Rachel H Prendergast, LCPC
• Presbyterian Home
• Presbyterian Homes
• Presbyterian Homes
• Presbyterian Homes Pharmacy
• Jennifer Preschern, MA CCC-SLP
• Robert V Prescott, PHD
• Presence Behavioral Health
• Presence Behavioral Health

• Rehabilitation Clinic/Center in Evanston, IL
• Providers in Evanston, IL by specialty
• Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.