Provider Demographics
NPI:1497180061
Name:GENESIS REHAB SERVICES
Entity Type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER / COTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKETA
Authorized Official - Middle Name:DHAVAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:734-306-3054
Mailing Address - Street 1:34330 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2472
Mailing Address - Country:US
Mailing Address - Phone:734-721-9108
Mailing Address - Fax:734-729-5782
Practice Address - Street 1:34330 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2472
Practice Address - Country:US
Practice Address - Phone:734-721-9108
Practice Address - Fax:734-729-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006033314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility