Provider Demographics
NPI:1689998494
Name:GENESIS REHAB SERVICES
Entity Type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDISON
Authorized Official - Suffix:
Authorized Official - Credentials:HUMAN RESOURCES
Authorized Official - Phone:610-925-4552
Mailing Address - Street 1:3827 PAXTON AVE APT 1012
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2425
Mailing Address - Country:US
Mailing Address - Phone:386-576-3660
Mailing Address - Fax:
Practice Address - Street 1:3827 PAXTON AVE APT 1012
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2425
Practice Address - Country:US
Practice Address - Phone:386-576-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0T.007485314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility