Healthcare Provider Details

I. General information

NPI: 1215220918
Provider Name (Legal Business Name): GENESIS ELDERCARE REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 ARTHUR BLVD
MERRILLVILLE IN
46410-3766
US

IV. Provider business mailing address

101 E STATE ST C/O AMY NUNEMAKER
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 219-649-7445
  • Fax:
Mailing address:
  • Phone: 610-925-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL ALLEN HIRSCHFELD
Title or Position: PRESIDENT
Credential:
Phone: 610-925-4025