Provider Demographics
NPI:1396989323
Name:GENESIS REHAB SERVICES
Entity type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARISE
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:WILSON-HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:757-463-0670
Mailing Address - Street 1:809 ADDISON CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6904
Mailing Address - Country:US
Mailing Address - Phone:757-463-0670
Mailing Address - Fax:
Practice Address - Street 1:809 ADDISON CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6904
Practice Address - Country:US
Practice Address - Phone:757-463-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004820310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119004820OtherVIRGINIA STATE OCCUPATIONAL THERAPY LICENSE