Basic Information
| Provider Information | |||||||||
| NPI: | 1720328784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS REHABILATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1402 MAPLE VILLAGE COURT | ||||||||
| Address2: | |||||||||
| City: | PELL CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35128 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 DEAN DRIVE | ||||||||
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| City: | GARDENDALE | ||||||||
| State: | ALABAMA | ||||||||
| PostalCode: | 35071 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 2056318709 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2013 | ||||||||
| LastUpdateDate: | 02/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | SHARELL | ||||||||
| AuthorizedOfficialMiddleName: | DENAISE | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6015725277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.