Healthcare Provider Details

I. General information

NPI: 1922348077
Provider Name (Legal Business Name): GENESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PENNKNOLL RD
EVERETT PA
15537-6940
US

IV. Provider business mailing address

2932 RAYSTOWN RD
HOPEWELL PA
16650-7622
US

V. Phone/Fax

Practice location:
  • Phone: 814-623-9018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberTEI001494
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DARCY KAGARISE
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential:
Phone: 814-652-0282