Healthcare Provider Details

I. General information

NPI: 1265768865
Provider Name (Legal Business Name): GENSIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 HILLVIEW DR
PENSACOLA FL
32514-5436
US

IV. Provider business mailing address

10100 HILLVIEW DR
PENSACOLA FL
32514-5436
US

V. Phone/Fax

Practice location:
  • Phone: 850-478-5153
  • Fax: 850-478-5152
Mailing address:
  • Phone: 850-478-5153
  • Fax: 850-478-5152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT11029
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STANFORD SPENCER
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 850-207-0755