Healthcare Provider Details

I. General information

NPI: 1285069203
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 COUNTRY VILLAGE RD
LANCASTER NH
03584-3142
US

IV. Provider business mailing address

91 COUNTRY VILLAGE RD
LANCASTER NH
03584-3142
US

V. Phone/Fax

Practice location:
  • Phone: 603-788-4735
  • Fax: 603-788-2404
Mailing address:
  • Phone: 603-788-4735
  • Fax: 603-788-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number1414
License Number StateNH

VIII. Authorized Official

Name: MR. JAMES R ABBRUSCATO
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 603-788-4735