Provider Demographics
NPI:1912023847
Name:GENESIS REHABILITATION SERVICES
Entity Type:Organization
Organization Name:GENESIS REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DASILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-852-4173
Mailing Address - Street 1:1881 SW 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-6429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6152 VERDE TRL N
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2430
Practice Address - Country:US
Practice Address - Phone:561-852-4173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10427314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility