Healthcare Provider Details

I. General information

NPI: 1912023847
Provider Name (Legal Business Name): GENESIS REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6152 VERDE TRL N
BOCA RATON FL
33433-2430
US

IV. Provider business mailing address

1881 SW 41ST AVE
FORT LAUDERDALE FL
33317-6429
US

V. Phone/Fax

Practice location:
  • Phone: 561-852-4173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10427
License Number StateFL

VIII. Authorized Official

Name: LUANN DASILVA
Title or Position: PROGRAM MANAGER
Credential:
Phone: 561-852-4173