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General NPI Number Information
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NPI Number | 1093836207
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB SERVICES
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4240 LAKELAND HIGHLANDS RD
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City | LAKELAND
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State | FL
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Zip | 33813-3113
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Country | US
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Telephone | 863-607-5948
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Fax | 863-644-4202
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Provider Business Mailing Address
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Address Line | 7916 SUGAR PINE BLVD
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City | LAKELAND
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State | FL
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Zip | 33810-1389
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Country | US
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Telephone | 863-868-3857
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Fax |
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Authorized Official
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Title or Position | REHAB PROGRAM MANAGER
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Name | MRS. KIMBERLY SUE OCHS
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Credential | MS CCC SLP
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Telephone | 863-607-5948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PTA20084
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License Number State | FL
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