Provider Demographics
NPI:1336585983
Name:GENESIS REHAB SERVICES
Entity Type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERT. OCCUPATIONAL THERAPY ASST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:LOVVORN
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:256-566-7963
Mailing Address - Street 1:80 COUNTY ROAD 72
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35619-5564
Mailing Address - Country:US
Mailing Address - Phone:256-566-7963
Mailing Address - Fax:
Practice Address - Street 1:1350 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4364
Practice Address - Country:US
Practice Address - Phone:256-355-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3357314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility