Healthcare Provider Details

I. General information

NPI: 1700253648
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

IV. Provider business mailing address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-9693
  • Fax:
Mailing address:
  • Phone: 239-573-9693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPTA25727
License Number StateFL

VIII. Authorized Official

Name: MISS BIANCA ASTRA NEMES
Title or Position: PTA
Credential: PTA25727
Phone: 727-485-3657