Healthcare Provider Details

I. General information

NPI: 1750647350
Provider Name (Legal Business Name): GENESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 BALDWIN AVE
NEGAUNEE MI
49866-1064
US

IV. Provider business mailing address

931 BALDWIN AVE
NEGAUNEE MI
49866-1064
US

V. Phone/Fax

Practice location:
  • Phone: 906-235-1911
  • Fax:
Mailing address:
  • Phone: 906-235-1911
  • 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: JILL NICHOLE WIECIECH
Title or Position: PROGRAM DIRECTOR
Credential: SLP
Phone: 906-204-2555