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General NPI Number Information
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NPI Number | 1265872600
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Entity Type | Organization
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Legal Business Name | GENESIS REHABILITATION
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Dates
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Enumeration Date | 06/30/2013
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Last Update Date | 06/30/2013
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Provider Practice Location Address
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Address Line | 11730 COOL HOLLOW RD
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City | GREENCASTLE
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State | PA
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Zip | 17225-9341
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Country | US
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Telephone | 717-597-2728
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Fax |
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Provider Business Mailing Address
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Address Line | 11730 COOL HOLLOW RD
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City | GREENCASTLE
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State | PA
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Zip | 17225-9341
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Country | US
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Telephone | 717-597-2728
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Fax |
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Authorized Official
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Title or Position | PTA
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Name | MRS. JAIME LYNN LONG
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Credential | PTA
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Telephone | 717-597-2728
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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 | A3093
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License Number State | MD
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