=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104101443
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS REHAB SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2011
-----------------------------------------------------
Last Update Date | 10/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9000 TWIN SILO DR
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19422-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-611-8727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9000 TWIN SILO DR
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19422-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | SIMONETTE LIBRE-SABIO
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 215-699-8727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | TOP008356
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------