Organization
GENESIS REHAB SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHANEL KATRECE PORTER-LAGRIER (PHYSICAL THERAPIST ASSISTANT)
(973) 220-0880
Entity
Organization
Contact information
Practice address
115 OLD SHORT HILLS RD, APARTMENT 254, WEST ORANGE, NJ 07052-1009
(973) 669-5658
Mailing address
115 OLD SHORT HILLS RD, APT. 254, WEST ORANGE, NJ 07052-1009
(973) 669-5658
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
40QB00278900
NJ
Other
Enumeration date
08/27/2011
Last updated
08/27/2011
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