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General NPI Number Information
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NPI Number | 1841948650
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Entity Type | Organization
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Legal Business Name | KIRBY REHABILITATION, INC
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 14014 PARK AVE
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City | DOLTON
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State | IL
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Zip | 60419-1029
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Country | US
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Telephone | 773-614-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 600 HOLIDAY PLAZA DR STE 170
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City | MATTESON
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State | IL
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Zip | 60443-2236
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Country | US
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Telephone | 708-248-6305
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LEA KIRBY
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Credential |
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Telephone | 773-614-4002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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