Basic Information
| Provider Information | |||||||||
| NPI: | 1700020880 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS HEALTH AND REHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3585 BRAMBLETON AVE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240186521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407761029 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3585 BRAMBLETON AVE | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240186521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407761029 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2009 | ||||||||
| LastUpdateDate: | 04/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | CRESSMAN | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | COTA | ||||||||
| AuthorizedOfficialTelephone: | 5407761029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0131000110 | VA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.