Healthcare Provider Details

I. General information

NPI: 1952711608
Provider Name (Legal Business Name): GENESIS HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 05/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 DELANEY CIR APT 102
BRANDON FL
33511-1943
US

IV. Provider business mailing address

924 DELANEY CIR APT 102
BRANDON FL
33511-1943
US

V. Phone/Fax

Practice location:
  • Phone: 941-920-1778
  • Fax:
Mailing address:
  • Phone: 941-920-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA 12220
License Number StateFL

VIII. Authorized Official

Name: MS. CHRISTEN MARIE CLARK
Title or Position: OCCUPATIONAL THERAPIST ASSISTANT
Credential: COTA
Phone: 941-920-1778