Basic Information
| Provider Information | |||||||||
| NPI: | 1386982643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS REHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8106 FORDHAM RD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900452556 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7716 W MANCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | PLAYA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902938408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108234694 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | SAUTTER | ||||||||
| AuthorizedOfficialFirstName: | ISABELLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3106496000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 19031 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.