Provider Demographics
NPI:1760025209
Name:GENESIS HEALTH DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:GENESIS HEALTH DEVELOPMENT, INC.
Other - Org Name:BROOKS REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTUGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-345-7158
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 WOODBURY RD STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4514
Practice Address - Country:US
Practice Address - Phone:407-373-6082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HEALTH DEVELOPMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-28
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation