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General NPI Number Information
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NPI Number | 1184088932
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Entity Type | Organization
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Legal Business Name | GENESIS MEDICAL AND REHABILITATION CENTER
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 5950 S WILLOW DR SUITE 200
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5170
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Country | US
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Telephone | 720-515-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 5950 S WILLOW DR SUITE 200
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-5170
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Country | US
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Telephone | 720-515-8002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLYDE JOHNSON
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Credential | DC
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Telephone | 720-515-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | CHR.0006922
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | CHR.0006922
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | EL.2786103
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License Number State | CO
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