Healthcare Provider Details

I. General information

NPI: 1366974875
Provider Name (Legal Business Name): GENESIS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 HARTFORD TPKE
VERNON CT
06066-4560
US

IV. Provider business mailing address

1253 HARTFORD TPKE
VERNON CT
06066-4560
US

V. Phone/Fax

Practice location:
  • Phone: 860-375-7315
  • Fax:
Mailing address:
  • Phone: 860-375-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000647
License Number StateCT

VIII. Authorized Official

Name: MRS. PATTY COSGROVE BARRESI
Title or Position: OCCUPATIONAL THERAPIST ASSISTANT
Credential: COTA/L
Phone: 860-375-7315