Healthcare Provider Details

I. General information

NPI: 1528349644
Provider Name (Legal Business Name): GENESIS REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 N. HALSTED UNIT A
CHICAGO IL
60642
US

IV. Provider business mailing address

1522 N HALSTED ST UNIT A
CHICAGO IL
60642-2528
US

V. Phone/Fax

Practice location:
  • Phone: 317-439-1411
  • Fax:
Mailing address:
  • Phone: 317-439-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateIL

VIII. Authorized Official

Name: KILEY DIANNE KITZINGER
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S.
Phone: 317-439-1411