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General NPI Number Information
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NPI Number | 1073499356
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTHCARE, INC.
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 830 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-3081
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Country | US
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Telephone | 843-781-7428
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Fax | 843-781-7429
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Provider Business Mailing Address
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Address Line | 8906 TWO NOTCH RD
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City | COLUMBIA
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State | SC
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Zip | 29223-6366
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Country | US
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Telephone | 803-254-3676
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Fax | 803-254-3678
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Authorized Official
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Title or Position | CEO
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Name | MR. TONY MEGNA
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Credential |
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Telephone | 803-254-3676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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