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General NPI Number Information
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NPI Number | 1386976942
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 175 BLUEBERRY LN
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City | LACONIA
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State | NH
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Zip | 03246-2918
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Country | US
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Telephone | 603-528-7036
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Fax |
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Provider Business Mailing Address
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Address Line | 175 BLUEBERRY LN
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City | LACONIA
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State | NH
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Zip | 03246-2918
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Country | US
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Telephone | 603-528-7036
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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 | BETHANNE LYNN PAGE
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Credential | M.S.
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Telephone | 603-630-3576
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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 | P-0429
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License Number State | NH
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