Provider Demographics
NPI:1265872600
Name:GENESIS REHABILITATION
Entity type:Organization
Organization Name:GENESIS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:717-597-2728
Mailing Address - Street 1:11730 COOL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-9341
Mailing Address - Country:US
Mailing Address - Phone:717-597-2728
Mailing Address - Fax:
Practice Address - Street 1:11730 COOL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-9341
Practice Address - Country:US
Practice Address - Phone:717-597-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-30
Last Update Date:2013-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3093314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility