Healthcare Provider Details

I. General information

NPI: 1790052868
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 AMBLESIDE DR
CLEVELAND OH
44106-4645
US

IV. Provider business mailing address

1830 W 28TH ST APT 8
CLEVELAND OH
44113-3019
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-2968
  • Fax:
Mailing address:
  • Phone: 330-240-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06415
License Number StateOH

VIII. Authorized Official

Name: KATHLEEN M O'LEARY
Title or Position: PTA
Credential:
Phone: 330-240-3624