Healthcare Provider Details

I. General information

NPI: 1225329170
Provider Name (Legal Business Name): GENESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 DARLING ST
NEWARK DE
19702-3761
US

IV. Provider business mailing address

167 DARLING ST
NEWARK DE
19702-3761
US

V. Phone/Fax

Practice location:
  • Phone: 302-983-2138
  • Fax:
Mailing address:
  • Phone: 302-983-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberTE0008861
License Number StateDE

VIII. Authorized Official

Name: MR. EDINSON A SALAZAR
Title or Position: PHYSICAL THERAPY ASSISTANT
Credential: PTA
Phone: 610-872-5373