Genesis Rehab

Key facts

NPI

1104058866

Entity type

Organization (NPI type 2)

Primary specialty

Health Maintenance Organization 302R00000X

License

SA6013 (FL)

Legal business name

GENESIS REHAB

Practice address

2626 Goodlette Rd N
Naples, FL 34103-4526

Phone

(239) 262-3814

Fax

(239) 262-5687

NPI assigned

Aug 13, 2009

Organization subpart

No

Authorized official

Name

Mrs. Stacy Cheryl Braverman, CCC-SLP NPI 1740519354

Title

Speech-Language Pathologist

Phone

(239) 282-3814

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy Cheryl Braverman Health Educator · Naples, FL · NPI 1740519354
  NPD (past) Authorized official

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 13, 2009.

{
    "created_epoch": "1250121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250121600000",
    "number": "1104058866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 RIDGE DR",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341083440",
            "telephone_number": "239-254-1020",
            "fax_number": "239-597-5289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 GOODLETTE RD N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341034526",
            "telephone_number": "239-262-3814",
            "fax_number": "239-262-5687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-13",
        "last_updated": "2009-08-13",
        "status": "A",
        "authorized_official_last_name": "BRAVERMAN",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "CHERYL",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "239-282-3814",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "FL",
            "license": "SA6013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Naples, FL · Health Maintenance Organization in Florida