Organization
GENESIS REHAB SERVICES
Active
Parent organization
AUTUM GREEN VILLAGE
Organization subpart
Yes
Provider details
NPI number
Legal business name
AUTUM GREEN VILLAGE
Authorized official
FERNANDO RODRIGUE PTA (PHYSICAL THERAPIST ASSISTANT)
(708) 469-8497
Entity
Organization
Contact information
Practice address
6700 S KEATING AVE, CHICAGO, IL 60629-5660
(773) 767-6262
Mailing address
2239 BURR OAK AVE, NORTH RIVERSIDE, IL 60546-1317
(708) 469-8497
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
160005776
IL
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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