Healthcare Provider Details

I. General information

NPI: 1598004103
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7716 W MANCHESTER AVE
PLAYA DEL REY CA
90293-8408
US

IV. Provider business mailing address

13921 S NORMANDIE AVE # 213
GARDENA CA
90249-2613
US

V. Phone/Fax

Practice location:
  • Phone: 310-823-4694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number15157
License Number StateCA

VIII. Authorized Official

Name: MR. RAHIM KANJI
Title or Position: REHAB PROGRAM MANAGER
Credential:
Phone: 310-823-4694