Provider Demographics
NPI:1356590848
Name:GENESIS REHAB, INC.
Entity type:Organization
Organization Name:GENESIS REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:334-289-5696
Mailing Address - Street 1:1351 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4125
Mailing Address - Country:US
Mailing Address - Phone:334-289-5696
Mailing Address - Fax:334-289-5578
Practice Address - Street 1:508 GREEN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-2316
Practice Address - Country:US
Practice Address - Phone:334-289-5696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS REHAB, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3269261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529927890Medicaid
Q46345Medicare UPIN
051556163Medicare PIN