MEDICARE: GENESIS REHAB SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	26144	FL

General Provider Information

NPI Number	:	1396119772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS REHAB SERVICES

Provider Business Mailing Address
First Line	:	32 REGAL PL
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2333
Country	:	US
Telephone Number	:	828-200-0490
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 REGAL PL
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2333
Country	:	US
Telephone Number	:	828-200-0490
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REHAB
Name	:	GRETCHEN CLARK
Credential	:	OT
Telephone Number	:	407-877-2394

Provider Enumeration Date	:	11/22/2015
Last Update Date	:	11/22/2015

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