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General NPI Number Information
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NPI Number | 1346579398
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Entity Type | Organization
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Legal Business Name | GENESIS REHABILITATION SERVICES
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 7120 N SHERIDAN RD # 201
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City | CHICAGO
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State | IL
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Zip | 60626-2900
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Country | US
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Telephone | 773-679-4006
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Fax |
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Provider Business Mailing Address
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Address Line | 7120 N SHERIDAN RD # 201
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City | CHICAGO
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State | IL
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Zip | 60626-2900
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Country | US
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Telephone | 773-679-4006
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | TINNA MARIE R. BOLONGAN
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Credential |
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Telephone | 773-679-4006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 070015702
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License Number State | IL
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