Provider Demographics
NPI:1952736407
Name:GENESIS REHAB SERVICES
Entity type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROYCE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:630-377-7092
Mailing Address - Street 1:3N226 LOBLOLLY LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7656
Mailing Address - Country:US
Mailing Address - Phone:630-377-7092
Mailing Address - Fax:
Practice Address - Street 1:3N226 LOBLOLLY LN
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7656
Practice Address - Country:US
Practice Address - Phone:630-377-7092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056002295310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility