Healthcare Provider Details

I. General information

NPI: 1407060247
Provider Name (Legal Business Name): GENESIS HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MARKET AVE N
CANTON OH
44702-1083
US

IV. Provider business mailing address

5932 SHAKERTOWN DR NW APT. J-9
CANTON OH
44718-9300
US

V. Phone/Fax

Practice location:
  • Phone: 330-430-2119
  • Fax:
Mailing address:
  • Phone: 330-412-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA 3558
License Number StateOH

VIII. Authorized Official

Name: MR. STEPHEN MICHAEL SEXTON
Title or Position: COTA/L
Credential:
Phone: 330-412-4863