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General NPI Number Information
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NPI Number | 1881010569
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Entity Type | Organization
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Legal Business Name | GENESISREHAB SERVICES
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 03/05/2014
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Provider Practice Location Address
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Address Line | 225 SAINT JOHN RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2918
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Country | US
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Telephone | 270-769-3314
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Fax |
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Provider Business Mailing Address
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Address Line | 225 SAINT JOHN RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2918
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Country | US
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Telephone | 270-769-3314
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Fax |
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Authorized Official
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Title or Position | PT
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Name | MR. MARK ALAN BURBA
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Credential |
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Telephone | 270-769-9733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | KY 002888
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License Number State | KY
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