Provider Demographics
NPI:1669800025
Name:GENESIS REHAB. SERVICES
Entity type:Organization
Organization Name:GENESIS REHAB. SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:JESSUP
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:336-351-3401
Mailing Address - Street 1:1471 DEER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-7407
Mailing Address - Country:US
Mailing Address - Phone:336-351-3401
Mailing Address - Fax:336-351-4344
Practice Address - Street 1:1471 DEER RD
Practice Address - Street 2:
Practice Address - City:MT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-1471
Practice Address - Country:US
Practice Address - Phone:336-351-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGALINE AYERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1722320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities