1538790241 NPI number — GENESIS ELDERCARE REHABILITATION SERVICES LLC

Table of content: (NPI 1538790241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538790241 NPI number — GENESIS ELDERCARE REHABILITATION SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS ELDERCARE REHABILITATION SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENESIS REHABILITATION SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538790241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-728-8808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2325 ROCKWELL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48642-9325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-898-9664
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SOIKA
Authorized Official First Name:
LOUISE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CSAO
Authorized Official Telephone Number:
610-925-4088

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)