Provider Demographics
NPI:1740604891
Name:GENESIS HEALTHCARE
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:480-221-9012
Mailing Address - Street 1:4239 N OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1410
Mailing Address - Country:US
Mailing Address - Phone:773-282-3652
Mailing Address - Fax:
Practice Address - Street 1:4239 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1410
Practice Address - Country:US
Practice Address - Phone:773-282-3652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002529261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy