Healthcare Provider Details

I. General information

NPI: 1083935746
Provider Name (Legal Business Name): GENESIS HEALTHCARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 WALNUT AVE
LONG BEACH CA
90813-3822
US

IV. Provider business mailing address

1201 WALNUT AVE
LONG BEACH CA
90813-3822
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7621
  • Fax: 562-591-3292
Mailing address:
  • Phone: 562-591-7621
  • Fax: 562-591-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number940000173
License Number StateCA

VIII. Authorized Official

Name: MR. RANDY L HENRY
Title or Position: PRESIDENT
Credential:
Phone: 818-888-1616