Healthcare Provider Details

I. General information

NPI: 1710229901
Provider Name (Legal Business Name): GENESIS REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FALMOUTH RD
MASHPEE MA
02649-2662
US

IV. Provider business mailing address

161 FALMOUTH RD
MASHPEE MA
02649-2662
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-2490
  • Fax: 508-477-9656
Mailing address:
  • Phone: 508-477-2490
  • Fax: 508-477-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1461
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DONALD SCHWARZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-681-1001