Healthcare Provider Details

I. General information

NPI: 1699178418
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

IV. Provider business mailing address

1509 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-4656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: THOMAS STATON
Title or Position: PROGRAM MANAGER
Credential: PT
Phone: 505-242-4656