Healthcare Provider Details

I. General information

NPI: 1104138924
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 BROOKLINE BLVD
PITTSBURGH PA
15226-1914
US

IV. Provider business mailing address

1522 BROOKLINE BLVD
PITTSBURGH PA
15226-1914
US

V. Phone/Fax

Practice location:
  • Phone: 412-477-3172
  • Fax:
Mailing address:
  • Phone: 412-477-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberTE008531
License Number StatePA

VIII. Authorized Official

Name: MR. FREDRICK ANDREW FAUST
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: PTA
Phone: 412-477-3172