Healthcare Provider Details

I. General information

NPI: 1205142858
Provider Name (Legal Business Name): GENESIS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EAST STATE STREET
KENNETT SQUARE PA
19348
US

IV. Provider business mailing address

101 EAST STATE STREET
KENNETT SQUARE PA
19348
US

V. Phone/Fax

Practice location:
  • Phone: 330-865-7227
  • Fax:
Mailing address:
  • Phone: 330-865-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03945
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number03945
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03945
License Number StateOH

VIII. Authorized Official

Name: MRS. CARRIE TESTA
Title or Position: DISTRICT MANAGER
Credential:
Phone: 330-865-7227