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General NPI Number Information
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NPI Number | 1275891012
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Entity Type | Organization
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Legal Business Name | GENESIS REHABILITATION SERVICES
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 1715 ELLINGTON RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2707
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Country | US
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Telephone | 860-432-9555
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 MAIN ST
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City | GLASTONBURY
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State | CT
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Zip | 06033-1030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | LIANA KINSELLA
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Credential |
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Telephone | 860-995-6906
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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 | 4409
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License Number State | CT
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