Provider Demographics
NPI:1598004103
Name:GENESIS REHAB SERVICES
Entity type:Organization
Organization Name:GENESIS REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KANJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-823-4694
Mailing Address - Street 1:13921 S NORMANDIE AVE # 213
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-2613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7716 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8408
Practice Address - Country:US
Practice Address - Phone:310-823-4694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS REHAB SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15157314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility