Provider Demographics
NPI:1730414699
Name:UNITED CARE REHAB, INC.
Entity type:Organization
Organization Name:UNITED CARE REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:BASTO
Authorized Official - Last Name:COLOMA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:815-409-8301
Mailing Address - Street 1:2203 PEMBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-7731
Mailing Address - Country:US
Mailing Address - Phone:815-409-8301
Mailing Address - Fax:
Practice Address - Street 1:2203 PEMBRIDGE LN
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-7731
Practice Address - Country:US
Practice Address - Phone:815-409-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-11
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty