Healthcare Provider Details

I. General information

NPI: 1578947016
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1550
US

IV. Provider business mailing address

4641 OLD CANOE CREEK RD
SAINT CLOUD FL
34769-1550
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-7357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number23981
License Number StateFL

VIII. Authorized Official

Name: FLOYD LAIDLAW
Title or Position: PTA
Credential:
Phone: 419-516-5389