Provider Demographics
NPI:1689971772
Name:GENESIS REHABILITATION
Entity Type:Organization
Organization Name:GENESIS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-786-2664
Mailing Address - Street 1:2210 RIDGE CREST LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2483
Mailing Address - Country:US
Mailing Address - Phone:336-366-2122
Mailing Address - Fax:
Practice Address - Street 1:2210 RIDGE CREST LN
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2483
Practice Address - Country:US
Practice Address - Phone:336-786-2664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation