Basic Information
| Provider Information | |||||||||
| NPI: | 1831485689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 GILL AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028614315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017227900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 GILL AVE | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028614315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017227900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2011 | ||||||||
| LastUpdateDate: | 06/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | COLLETTE | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPY ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4017227900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PTA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | PTA00767 | RI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.