1174822472 NPI number — GENESIS REHAB SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174822472 NPI number — GENESIS REHAB SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS REHAB SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174822472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 KIEHNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHUYLKILL HAVEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17972-8999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-739-4526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 KIEHNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHUYLKILL HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17972-8999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-739-4526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROEDER
Authorized Official First Name:
DARCIE
Authorized Official Middle Name:
NAN
Authorized Official Title or Position:
PHY. THERAPY ASSISTANT
Authorized Official Telephone Number:
570-621-7432

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  TE1000270 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TE1000270 . This is a "PT ASSISTANT PENNSYLVANIA STATE LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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