Healthcare Provider Details

I. General information

NPI: 1184165185
Provider Name (Legal Business Name): GENESIS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 ILIFF DR
DUNN LORING VA
22027-1235
US

IV. Provider business mailing address

8000 ILIFF DR
DUNN LORING VA
22027-1235
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-1000
  • Fax:
Mailing address:
  • Phone: 703-560-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2306601458
License Number StateVA

VIII. Authorized Official

Name: LINDSAY GARCIA
Title or Position: DIRECTOR OF REHAB
Credential:
Phone: 703-560-1000