Healthcare Provider Details

I. General information

NPI: 1538543723
Provider Name (Legal Business Name): GENESIS HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W. MAIN ST.
LAMAR SC
29069
US

IV. Provider business mailing address

8906 TWO NOTCH RD
COLUMBIA SC
29223-6366
US

V. Phone/Fax

Practice location:
  • Phone: 843-395-8400
  • Fax:
Mailing address:
  • Phone: 803-254-3676
  • Fax: 803-254-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TONY MEGNA
Title or Position: CEO
Credential:
Phone: 803-254-3676