Healthcare Provider Details

I. General information

NPI: 1720359185
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 PALM COAST PKWY SE
PALM COAST FL
32137-8209
US

IV. Provider business mailing address

3001 PALM COAST PKWY SE
PALM COAST FL
32137-8209
US

V. Phone/Fax

Practice location:
  • Phone: 386-446-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA11753
License Number StateFL

VIII. Authorized Official

Name: REBECCA HALEY
Title or Position: VP, HUMAN RESOURCES
Credential:
Phone: 800-243-4556