Healthcare Provider Details

I. General information

NPI: 1780955724
Provider Name (Legal Business Name): GENESIS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 OAK ST
GREEN COVE SPRINGS FL
32043-4317
US

IV. Provider business mailing address

803 OAK ST
GREEN COVE SPRINGS FL
32043-4317
US

V. Phone/Fax

Practice location:
  • Phone: 902-284-5606
  • Fax:
Mailing address:
  • Phone: 904-284-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5201
License Number StateFL

VIII. Authorized Official

Name: MRS. CAROLE LOUISE RIVERA
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 904-284-5606