Healthcare Provider Details

I. General information

NPI: 1659664431
Provider Name (Legal Business Name): GENESIS ELDERCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 HAMMONDS LN
BROOKLYN PARK MD
21225-3351
US

IV. Provider business mailing address

613 HAMMONDS LN
BROOKLYN PARK MD
21225-3351
US

V. Phone/Fax

Practice location:
  • Phone: 410-350-8514
  • Fax: 410-636-8931
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number224Z00000X
License Number StateMD

VIII. Authorized Official

Name: MS. MONIQUE PRICE
Title or Position: PROGRAM MANAGER
Credential:
Phone: 410-350-8514