Provider Demographics
NPI:1447546155
Name:GENESIS REHAB
Entity type:Organization
Organization Name:GENESIS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPTIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHECRALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:401-722-7900
Mailing Address - Street 1:70 GILL AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-4315
Mailing Address - Country:US
Mailing Address - Phone:401-722-7900
Mailing Address - Fax:
Practice Address - Street 1:70 GILL AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-4315
Practice Address - Country:US
Practice Address - Phone:401-722-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility