Healthcare Provider Details

I. General information

NPI: 1619362381
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 COOL ST
WATERVILLE ME
04901-5221
US

IV. Provider business mailing address

27 COOL ST
WATERVILLE ME
04901-5221
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-0721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOA2577
License Number StateME

VIII. Authorized Official

Name: PAMELA BRAZIER
Title or Position: OCCUPATIONAL THERAPY ASSISTANT
Credential:
Phone: 208-873-0721