Healthcare Provider Details

I. General information

NPI: 1629247952
Provider Name (Legal Business Name): GENESIS REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 CHESBROUGH BLVD
ROCK HILL SC
29732-8078
US

IV. Provider business mailing address

200 BRICKSTONE SQ
ANDOVER MA
01810-1437
US

V. Phone/Fax

Practice location:
  • Phone: 803-328-5244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2745
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2745
License Number StateSC

VIII. Authorized Official

Name: PAULA WITTS
Title or Position: HUMAN RESOURCES REPRESENTATIVE
Credential:
Phone: 18008044494