Healthcare Provider Details

I. General information

NPI: 1194234773
Provider Name (Legal Business Name): GENESIS ELDERCARE REHABILITATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 LADYS ISLAND DR
PORT ROYAL SC
29935-1106
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 843-940-7053
  • Fax:
Mailing address:
  • Phone: 610-925-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOUISE ANN SOIKA
Title or Position: SVP
Credential:
Phone: 610-925-4088