Healthcare Provider Details

I. General information

NPI: 1174688287
Provider Name (Legal Business Name): GENERATION HEALTH & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W. MAIN STREET
NEWARK OH
43055-3653
US

IV. Provider business mailing address

1450 W. MAIN STREET
NEWARK OH
43055-3653
US

V. Phone/Fax

Practice location:
  • Phone: 740-348-1300
  • Fax: 740-344-3091
Mailing address:
  • Phone: 740-348-1300
  • Fax: 740-344-3091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1489N
License Number StateOH

VIII. Authorized Official

Name: KAREN R KELLER
Title or Position: CFO/OWNER
Credential:
Phone: 740-348-1389