Healthcare Provider Details

I. General information

NPI: 1861770745
Provider Name (Legal Business Name): GENESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WOODLAND DR
COVENTRY RI
02816-6716
US

IV. Provider business mailing address

10 WOODLAND DR
COVENTRY RI
02816-6716
US

V. Phone/Fax

Practice location:
  • Phone: 401-826-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPTA00760
License Number StateRI

VIII. Authorized Official

Name: LISA WALKIN
Title or Position: PROGRAM MANAGER
Credential: MS PT GCS
Phone: 401-826-2000