Basic Information
| Provider Information | |||||||||
| NPI: | 1598004103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENESIS REHAB SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13921 S NORMANDIE AVE # 213 | ||||||||
| Address2: | |||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902492613 | ||||||||
| 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: | 02/04/2013 | ||||||||
| LastUpdateDate: | 02/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | KANJI | ||||||||
| AuthorizedOfficialFirstName: | RAHIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | REHAB PROGRAM MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3108234694 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENESIS REHAB SERVICES | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 15157 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.