Healthcare Provider Details

I. General information

NPI: 1972628188
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 LAKESHORE DR
LEWES DE
19958-9582
US

IV. Provider business mailing address

11 LAKESHORE DR
LEWES DE
19958-9582
US

V. Phone/Fax

Practice location:
  • Phone: 302-463-8080
  • Fax:
Mailing address:
  • Phone: 302-463-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number01-0000831
License Number StateDE

VIII. Authorized Official

Name: MRS. HOLLY STAUFFER TORI
Title or Position: SPEECH PATHOLOGIST
Credential: MSCCCSLP
Phone: 302-463-8080