Healthcare Provider Details

I. General information

NPI: 1912375056
Provider Name (Legal Business Name): GENESIS HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2015
Last Update Date: 09/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 HARTS RD
JACKSONVILLE FL
32218-3777
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 904-751-1834
  • Fax:
Mailing address:
  • Phone: 610-925-2205
  • Fax: 610-612-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE ROUCO
Title or Position: HUMAN RESOURCES GENERALIST
Credential:
Phone: 16109252205