Basic Information
| Provider Information | |||||||||
| NPI: | 1891010617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS REHABILITATION SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S BROAD ST | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009929711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3 MERIT DR | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441431457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162619600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 04/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | KRYSTAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2162619600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OTA 04357 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.