Provider Demographics
NPI:1699143297
Name:GENESIS ELDER CARE REHABILITATION SERVICES, INC
Entity type:Organization
Organization Name:GENESIS ELDER CARE REHABILITATION SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THREALIST/REHAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, RD
Authorized Official - Phone:813-727-7741
Mailing Address - Street 1:813 KELLER LN
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1110
Mailing Address - Country:US
Mailing Address - Phone:256-383-1535
Mailing Address - Fax:
Practice Address - Street 1:813 KELLER LN
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1110
Practice Address - Country:US
Practice Address - Phone:256-383-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility