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General NPI Number Information
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NPI Number | 1699178418
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB SERVICES
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 1509 UNIVERSITY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-1708
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Country | US
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Telephone | 505-242-4656
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 UNIVERSITY BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-1708
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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 | PROGRAM MANAGER
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Name | THOMAS STATON
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Credential | PT
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Telephone | 505-242-4656
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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 |
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License Number State |
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