MEDICARE: GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0809	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2222525310	OTHER	MA	BC/BS - OUTPATIENT REHAB
3	000000021321	OTHER		BOSTON MEDICAL CENTER
4	2222525302	OTHER	MA	BC/BS - VENT
5	82566	OTHER		AETNA-HMO
6	0020937	OTHER		NEIGHBORHOOD HEALTH PLAN
7	36009	OTHER		HEALTH NEW ENGLAND
8	71-01268	OTHER		UNITED - EVERCARE
9	905656	OTHER		HARVARD PILGRAM
10	1580361	OTHER		CIGNA(HEALTHSOURCE OF MA)
11	2222525301	OTHER	MA	BC/BS

General Provider Information

NPI Number	:	1053353060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:	610-925-4436
Fax Number	:	610-925-4351

Provider Business Practice Location Address
First Line	:	61 COOPER ST
Second Line	:
City	:	AGAWAM
State	:	MA
Zip	:	01001-2149
Country	:	US
Telephone Number	:	413-786-8000
Fax Number	:	413-786-5066

Authorized Official
Title or Position	:	CORPORATE MANAGER
Name	:	JANE DROPESKEY
Credential	:
Telephone Number	:	610-925-4231

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/21/2018

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