Healthcare Provider Details

I. General information

NPI: 1518357763
Provider Name (Legal Business Name): GENESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 ORANGE AVE
SANTA ANA CA
92707-1323
US

IV. Provider business mailing address

1313 ORANGE AVE
SANTA ANA CA
92707-1323
US

V. Phone/Fax

Practice location:
  • Phone: 714-913-5597
  • Fax:
Mailing address:
  • Phone: 714-913-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2408
License Number StateCA

VIII. Authorized Official

Name: SARA ARACELI CALDERON
Title or Position: COTA
Credential:
Phone: 714-913-5597