Provider Demographics
NPI:1790230571
Name:GREENFIELD REHABILITATION AGENCY, INC.
Entity Type:Organization
Organization Name:GREENFIELD REHABILITATION AGENCY, INC.
Other - Org Name:REHAB RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA, GCS, RAC-CT
Authorized Official - Phone:262-923-7101
Mailing Address - Street 1:3360 GATEWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-5115
Mailing Address - Country:US
Mailing Address - Phone:262-923-7101
Mailing Address - Fax:262-923-7178
Practice Address - Street 1:3360 GATEWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-5115
Practice Address - Country:US
Practice Address - Phone:262-923-7101
Practice Address - Fax:262-923-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100062347Medicaid
WI41805600Medicaid