# GENESIS REHAB SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AUTUM GREEN VILLAGE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932453347
- **Legal business name:** AUTUM GREEN VILLAGE
- **Authorized official:** FERNANDO RODRIGUE PTA (PHYSICAL THERAPIST ASSISTANT)
- **Authorized official phone:** (708) 469-8497

## Contact information

- **Practice address:** 6700 S KEATING AVE, CHICAGO, IL 60629-5660
- **Practice address phone:** (773) 767-6262
- **Mailing address:** 2239 BURR OAK AVE, NORTH RIVERSIDE, IL 60546-1317
- **Mailing address phone:** (708) 469-8497

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 160005776 | IL | Yes |

## Other

- **Enumeration date:** 11/07/2012
- **Last updated:** 11/07/2012