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General NPI Number Information
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NPI Number | 1568688083
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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 | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4240 LAKELAND HIGHLANDS RD
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City | LAKELAND
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State | FL
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Zip | 33813-3113
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Country | US
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Telephone | 863-607-5948
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Fax |
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Provider Business Mailing Address
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Address Line | 6651 ENGLELAKE DR
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City | LAKELAND
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State | FL
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Zip | 33813-3774
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Country | US
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Telephone | 863-701-9664
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Fax |
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Authorized Official
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Title or Position | REHAB MANAGER
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Name | KIMBERLY OCHS
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Credential | MSCCCSLP
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Telephone | 863-607-5948
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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 | PT21084
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License Number State | FL
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