Provider Demographics
NPI:1992029284
Name:GENESIS ELDERCARE REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:GENESIS ELDERCARE REHABILITATION SERVICES LLC
Other - Org Name:GENESIS REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HIRSCHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4025
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:C/O AMY NUNEMAKER
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4560
Mailing Address - Fax:
Practice Address - Street 1:735 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1435
Practice Address - Country:US
Practice Address - Phone:401-949-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0015475Medicare Oscar/Certification