Healthcare Provider Details

I. General information

NPI: 1396119772
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2015
Last Update Date: 11/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 REGAL PL
WINTER GARDEN FL
34787-2333
US

IV. Provider business mailing address

32 REGAL PL
WINTER GARDEN FL
34787-2333
US

V. Phone/Fax

Practice location:
  • Phone: 828-200-0490
  • Fax:
Mailing address:
  • Phone: 828-200-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number26144
License Number StateFL

VIII. Authorized Official

Name: GRETCHEN CLARK
Title or Position: DIRECTOR OF REHAB
Credential: OT
Phone: 407-877-2394