MEDICARE: GENESIS HEALTH & REHAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	363L00000X	Nurse Practitioner
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1982974820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS HEALTH & REHAB, LLC

Provider Business Mailing Address
First Line	:	1900 DERITA RD STE 103
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-3355
Country	:	US
Telephone Number	:	980-200-4259
Fax Number	:	404-382-6005

Provider Business Practice Location Address
First Line	:	8380 SW 124TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-5835
Country	:	US
Telephone Number	:	305-238-4800
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. STEPHEN WRIGHT
Credential	:	MBA
Telephone Number	:	980-200-4259

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	01/10/2012

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