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General NPI Number Information
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NPI Number | 1265841001
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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 | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 120 LAKES AT LITCHFIELD DR
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-5502
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Country | US
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Telephone | 843-237-0343
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Fax | 843-235-4024
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Provider Business Mailing Address
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Address Line | 120 LAKES AT LITCHFIELD DR
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-5502
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Country | US
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Telephone | 843-237-0343
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Fax | 843-235-4024
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | ROBERT PREIST
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Credential | PM
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Telephone | 843-237-0343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | OTA.3001 OTA
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License Number State | SC
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