Provider Demographics
NPI:1699031492
Name:GENESIS REHAB SERVICES
Entity Type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:570-622-9666
Mailing Address - Street 1:639 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3723
Mailing Address - Country:US
Mailing Address - Phone:570-294-2475
Mailing Address - Fax:
Practice Address - Street 1:1000 SCHUYLKILL MANOR RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3862
Practice Address - Country:US
Practice Address - Phone:570-622-9666
Practice Address - Fax:570-622-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011751314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility