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General NPI Number Information
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NPI Number | 1124273545
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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 | 11/26/2008
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Last Update Date | 11/26/2008
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Provider Practice Location Address
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Address Line | 7201 GREENBORO DR APT 7
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1698
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Country | US
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Telephone | 321-412-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 7570 GREENBORO DR APT 7
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1642
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Country | US
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Telephone | 321-412-5716
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Fax |
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Authorized Official
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Title or Position | COTA/L
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Name | MS. KELLY R CHANDLER
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Credential | COTA/L
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Telephone | 321-412-5716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | OTA10545
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License Number State | FL
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