Provider Demographics
NPI:1720328784
Name:GENESIS REHABILATION
Entity Type:Organization
Organization Name:GENESIS REHABILATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARELL
Authorized Official - Middle Name:DENAISE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:601-572-5277
Mailing Address - Street 1:1402 MAPLE VILLAGE COURT
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 DEAN DRIVE
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:ALABAMA
Practice Address - Zip Code:35071
Practice Address - Country:UM
Practice Address - Phone:205-631-8709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility