Healthcare Provider Details

I. General information

NPI: 1952698649
Provider Name (Legal Business Name): GENESIS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 FRANK PRESSLEY DR.
DUE WEST SC
29639-5259
US

IV. Provider business mailing address

95 AUSTIN DR
ABBEVILLE SC
29620-5259
US

V. Phone/Fax

Practice location:
  • Phone: 864-379-2490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1919A
License Number StateSC

VIII. Authorized Official

Name: KRISTI MILLER
Title or Position: COTA/L
Credential:
Phone: 864-992-4968