Provider Demographics
NPI:1033154992
Name:GENESIS HEALTH DEVELOPMENT INC
Entity Type:Organization
Organization Name:GENESIS HEALTH DEVELOPMENT INC
Other - Org Name:BROOKS REHAB CENTER/LOW VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-345-7473
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-345-7291
Mailing Address - Fax:904-345-7284
Practice Address - Street 1:3901 UNIVERSITY BLVD S STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4374
Practice Address - Country:US
Practice Address - Phone:904-389-9989
Practice Address - Fax:904-389-1060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HEALTH DEVELOPMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8869570-05Medicaid
FL686580Medicare Oscar/Certification