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General NPI Number Information
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NPI Number | 1568806750
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB SERVICES
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 901 NEWCASTLE DR APT 3
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1814
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Country | US
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Telephone | 217-549-8829
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Fax |
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Provider Business Mailing Address
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Address Line | 901 NEWCASTLE DR APT 3
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1814
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Country | US
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Telephone | 217-549-8829
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | TIFFANY COTTRILL
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Credential | MS CCC-SLP
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Telephone | 217-549-8829
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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 | 146009784
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License Number State | IL
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