Healthcare Provider Details

I. General information

NPI: 1356785612
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 NORWOOD RD
SANDY SPRING MD
20860-1236
US

IV. Provider business mailing address

17401 NORWOOD RD
SANDY SPRING MD
20860-1236
US

V. Phone/Fax

Practice location:
  • Phone: 301-924-7527
  • Fax:
Mailing address:
  • Phone: 301-924-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06617
License Number StateMD

VIII. Authorized Official

Name: MS. JESSICA ANN RICHARDSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 304-841-1687