Healthcare Provider Details

I. General information

NPI: 1871844928
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 W 87TH ST
CHICAGO IL
60652-3832
US

IV. Provider business mailing address

2940 W 87TH ST
CHICAGO IL
60652-3832
US

V. Phone/Fax

Practice location:
  • Phone: 773-306-0260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SARAH LEBLANC
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 508-277-8623