=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356648992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS REHAB SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2011
-----------------------------------------------------
Last Update Date | 03/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 NORTH EASTON RD
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-1901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-830-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1113 NORTH EASTON RD
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-1901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | CASSIE NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-830-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | TOC102075
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | OC011794
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------