Basic Information
| Provider Information | |||||||||
| NPI: | 1447574553 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11841 ABBEY ROAD | ||||||||
| Address2: | |||||||||
| City: | NORTH ROYALTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402373112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4360 BRECKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | RICHFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442869457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306596166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 03/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOGAN | ||||||||
| AuthorizedOfficialFirstName: | BETHANY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3307604989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OTA 04109 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.