Healthcare Provider Details

I. General information

NPI: 1427376193
Provider Name (Legal Business Name): GENUINE CARE REHABILITATION SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 BROADWAY EXT SUITE 204
OKLAHOMA CITY OK
73116-9031
US

IV. Provider business mailing address

7510 BROADWAY EXT SUITE 204
OKLAHOMA CITY OK
73116-9031
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-8505
  • Fax: 405-842-8805
Mailing address:
  • Phone: 405-842-8505
  • Fax: 405-842-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number42
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number42
License Number StateOK

VIII. Authorized Official

Name: MR. BLAKE EVAN BARLOW
Title or Position: PRESIDENT
Credential: CP, LPO, FAAOP
Phone: 405-842-8505