Provider Demographics
NPI:1467856641
Name:GENESUS REHAB SERVICES
Entity Type:Organization
Organization Name:GENESUS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICAL
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4477
Mailing Address - Street 1:1104 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 WELSH RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3730
Practice Address - Country:US
Practice Address - Phone:215-676-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009839314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility