Provider Demographics
NPI:1669039400
Name:GENESIS HEALTH DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:GENESIS HEALTH DEVELOPMENT, INC.
Other - Org Name:BROOKS REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:ATTN MANAGED CARE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-345-7291
Mailing Address - Fax:904-345-7284
Practice Address - Street 1:463721 SR 200
Practice Address - Street 2:, SUITE 7
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097
Practice Address - Country:US
Practice Address - Phone:904-602-6088
Practice Address - Fax:904-602-6091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HEALTH DEVELOPMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-28
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation