Basic Information
| Provider Information | |||||||||
| NPI: | 1922585991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS ELDERCARE REHAB SVCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9404 OWINGS HEIGHTS CIR APT 304 | ||||||||
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| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211176396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439330808 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 WILKENS AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212294610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105251544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2018 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | SARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH THERAPIST-CLINICAL FELLOW | ||||||||
| AuthorizedOfficialTelephone: | 4439330808 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.