Healthcare Provider Details

I. General information

NPI: 1760766471
Provider Name (Legal Business Name): GENESIS HEALTH AND REHAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 HERITAGE VILLAGE PLZ
GAINESVILLE VA
20155-3078
US

IV. Provider business mailing address

7501 HERITAGE VILLAGE PLAZA
GAINESVILLE VA
20155
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2305206550
License Number StateVA

VIII. Authorized Official

Name: JENNIFER HARDY
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 703-772-7253