Provider Demographics
NPI:1174822472
Name:GENESIS REHAB SERVICES
Entity Type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:SCHUYLKILL MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHY. THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARCIE
Authorized Official - Middle Name:NAN
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-621-7432
Mailing Address - Street 1:14 KIEHNER RD
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-8999
Mailing Address - Country:US
Mailing Address - Phone:570-739-4526
Mailing Address - Fax:
Practice Address - Street 1:14 KIEHNER RD
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-8999
Practice Address - Country:US
Practice Address - Phone:570-739-4526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000270302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATE1000270OtherPT ASSISTANT PENNSYLVANIA STATE LICENSE