Healthcare Provider Details

I. General information

NPI: 1225162100
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BABCOCK AVE
PLAINFIELD CT
06374-1226
US

IV. Provider business mailing address

PO BOX 143
DANIELSON CT
06239-0143
US

V. Phone/Fax

Practice location:
  • Phone: 860-564-3387
  • Fax:
Mailing address:
  • Phone: 860-774-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000475
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CINDY SANDBERG
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: LPTA
Phone: 860-774-1311