Basic Information
| Provider Information | |||||||||
| NPI: | 1568584928 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENESIS HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 UNGER AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453222027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378323250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1390 KING TREE DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454051401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372780723 | ||||||||
| FaxNumber: | 9372768675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2007 | ||||||||
| LastUpdateDate: | 07/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | JACOBS | ||||||||
| AuthorizedOfficialFirstName: | MELINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | THERAPY MGR | ||||||||
| AuthorizedOfficialTelephone: | 9378299056 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | OTA 02070 | OH | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.