Basic Information
| Provider Information | |||||||||
| NPI: | 1083842991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS REHAB SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CIVIC AVENUE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21804 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 200 CIVIC AVE | ||||||||
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| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218044599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107491466 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 06/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | FRATANDUONO | ||||||||
| AuthorizedOfficialFirstName: | MEGAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4107491466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 05962 | MD | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.