Healthcare Provider Details

I. General information

NPI: 1760889083
Provider Name (Legal Business Name): GENSIS REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 17TH AVE S
GREAT FALLS MT
59405-4523
US

IV. Provider business mailing address

1130 17TH AVE S
GREAT FALLS MT
59405-4523
US

V. Phone/Fax

Practice location:
  • Phone: 406-590-9561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2402
License Number StateMT

VIII. Authorized Official

Name: MRS. CAROLYN E JOHNSTON
Title or Position: PTA
Credential:
Phone: 406-590-9561