Healthcare Provider Details

I. General information

NPI: 1356648992
Provider Name (Legal Business Name): GENESIS REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 NORTH EASTON RD
WILLOW GROVE PA
19090-1901
US

IV. Provider business mailing address

1113 NORTH EASTON RD
WILLOW GROVE PA
19090-1901
US

V. Phone/Fax

Practice location:
  • Phone: 215-830-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberTOC102075
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOC011794
License Number StatePA

VIII. Authorized Official

Name: CASSIE NELSON
Title or Position: PROGRAM MANAGER
Credential:
Phone: 215-830-5400