Basic Information
| Provider Information | |||||||||
| NPI: | 1912375056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS HEALTHCARE CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STATE ST | ||||||||
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| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109252205 | ||||||||
| FaxNumber: | 6106123297 | ||||||||
| Practice Location | |||||||||
| Address1: | 11565 HARTS RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322183777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047511834 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2015 | ||||||||
| LastUpdateDate: | 09/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROUCO | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES GENERALIST | ||||||||
| AuthorizedOfficialTelephone: | 16109252205 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech |
No ID Information.