Elm City Rehabilitation Center, Inc.

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

0517 Issued in IL

Legal business name

ELM CITY REHABILITATION CENTER, INC.

Practice address

1314 W Walnut St
Jacksonville, IL 62650-1148

Phone

(217) 245-9504

Fax

(217) 245-2350

NPI assigned

Jun 23, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Thomas R. Frederick

Title

President/Ceo

Phone

(217) 245-9504

Specialties & licenses 2

Addresses

Other names 1

• Elm City Center Doing business as

Tax ID family

Elm City Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Elm City Rehabilitation Center, Inc.

  • Community/Behavioral Health Agency
  • Jacksonville, IL
  • NPI 1023258456
  NPD tax ID
• Elm City Rehabilitation Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jacksonville, IL
  • NPI 1104061662
  NPD tax ID
• Elm City Rehabilitation Center, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Jacksonville, IL
  • NPI 1902934102
  NPD tax ID

Locations

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466640000000",
    "number": "1679924450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 W WALNUT ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501148",
            "telephone_number": "217-245-9504",
            "fax_number": "217-245-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 W WALNUT ST",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626501148",
            "telephone_number": "217-245-9504",
            "fax_number": "217-245-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELM CITY REHABILITATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "217-245-9504",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "IL",
            "license": "0517",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "201200001S",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elm City Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathy Moore Dyson, LCPC
• Babu Rao Eladasari, MD,FACP
• Eldon G Barrowes DDS & Assoc PC
• Elm City Rehabilitation Center, Inc.
• Elm City Rehabilitation Center, Inc.
• Elm City Rehabilitation Center, Inc.
• Empowerme Rehabilitation Il Agency, LLC
• Valerie Ernst, PT
• Ryan D. Farris, AUD
• Lori Ann Feezor-Ribble, O.D.

• Developmentally Disabled Services Day Training Agency in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Developmentally Disabled Services Day Training Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.