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NPI Code Detail

MEDICARE: GENESIS REHABILITATION SERVICES

MEDICARE: GENESIS REHABILITATION SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility070015702IL

General Provider Information

NPI Number : 1346579398
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS REHABILITATION SERVICES
Provider Business Mailing Address
First Line : 7120 N SHERIDAN RD
Second Line : # 201
City : CHICAGO
State : IL
Zip : 60626-2900
Country : US
Telephone Number : 773-679-4006
Fax Number :
Provider Business Practice Location Address
First Line : 7120 N SHERIDAN RD
Second Line : # 201
City : CHICAGO
State : IL
Zip : 60626-2900
Country : US
Telephone Number : 773-679-4006
Fax Number :
Authorized Official
Title or Position : PHYSICAL THERAPIST
Name : TINNA MARIE R. BOLONGAN
Credential :
Telephone Number : 773-679-4006
Provider Enumeration Date : 12/21/2009
Last Update Date : 12/21/2009

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Directions to “GENESIS REHABILITATION SERVICES ” Practice Location

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