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General NPI Number Information
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NPI Number | 1740604891
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTHCARE
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 4239 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60634-1410
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Country | US
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Telephone | 773-282-3652
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Fax |
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Provider Business Mailing Address
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Address Line | 4239 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60634-1410
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Country | US
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Telephone | 773-282-3652
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | JANE FRANCES CARTER
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Credential | PTA
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Telephone | 480-221-9012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 160002529
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License Number State | IL
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