MEDICARE: GENESIS ELDERCARE REHABILITATION SERVICES LLC

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1952710378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS ELDERCARE REHABILITATION SERVICES LLC

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:	C/O AMY NUNEMAKER
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:	610-925-4560
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 OSPREY VILLAGE DR
Second Line	:	C/O OSPREY VILLAGE AT AMELIA ISLAND
City	:	AMELIA ISLAND
State	:	FL
Zip	:	32034-4955
Country	:	US
Telephone Number	:	904-491-1701
Fax Number	:

Authorized Official
Title or Position	:	SVP
Name	:	LOUISE ANN SOIKA
Credential	:
Telephone Number	:	610-925-4088

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	02/13/2018

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