Provider Demographics
NPI:1891020137
Name:THE GENESIS THERAPY CENTER
Entity Type:Organization
Organization Name:THE GENESIS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-535-7320
Mailing Address - Street 1:6006 159TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2904
Mailing Address - Country:US
Mailing Address - Phone:708-535-7320
Mailing Address - Fax:708-535-7571
Practice Address - Street 1:6006 WEST 159TH STREET
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2904
Practice Address - Country:US
Practice Address - Phone:708-535-7320
Practice Address - Fax:708-535-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005630251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health