Provider Demographics
NPI:1073757613
Name:GENESIS REHAB SERVICES
Entity Type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPTA
Authorized Official - Prefix:MS
Authorized Official - First Name:DELPHIS
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-825-0445
Mailing Address - Street 1:305 MARCELLA RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2433
Mailing Address - Country:US
Mailing Address - Phone:757-825-0445
Mailing Address - Fax:757-838-3542
Practice Address - Street 1:305 MARCELLA RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2433
Practice Address - Country:US
Practice Address - Phone:757-825-0445
Practice Address - Fax:757-838-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602465314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility