Basic Information
| Provider Information | |||||||||
| NPI: | 1811907462 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENFIELD REHABILITATION AGENCY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3360 GATEWAY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530455115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629237101 | ||||||||
| FaxNumber: | 2629237178 | ||||||||
| Practice Location | |||||||||
| Address1: | 3360 GATEWAY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530455115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629237178 | ||||||||
| FaxNumber: | 2629237178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2629237101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, MBA, GCS, RAC-CT | ||||||||
| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 41805600 | 05 | WI | MEDICAID |