Healthcare Provider Details

I. General information

NPI: 1841948650
Provider Name (Legal Business Name): KIRBY REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14014 PARK AVE
DOLTON IL
60419-1029
US

IV. Provider business mailing address

600 HOLIDAY PLAZA DR STE 170
MATTESON IL
60443-2236
US

V. Phone/Fax

Practice location:
  • Phone: 773-614-4002
  • Fax:
Mailing address:
  • Phone: 708-248-6305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEA KIRBY
Title or Position: CEO
Credential:
Phone: 773-614-4002