Basic Information
| Provider Information | |||||||||
| NPI: | 1255697199 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENESIS REHAB SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 JOHN ASHLEY DR | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721141815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017583800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2501 JOHN ASHLEY DR | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721141815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017583800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2012 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | TILTON | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OT | ||||||||
| AuthorizedOfficialTelephone: | 5017583800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | PT 3444 | AR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.