1962529735 NPI number — GENESIS ELDERCARE REHAB SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962529735 NPI number — GENESIS ELDERCARE REHAB SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS ELDERCARE REHAB SERVICES
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:
Provider Other Organization Name Type Code:
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:
1962529735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 BARK HOLLOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORSHAM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19044-1969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-444-9102
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3485 DAVISVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19040-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-830-5127
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHUNG
Authorized Official First Name:
EUN-HEH
Authorized Official Middle Name:
GRACE
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
215-830-5127

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OC002550L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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