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General NPI Number Information
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NPI Number | 1093349516
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTHCARE LLC
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 7193 SWINNEA RD STE A
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6351
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Country | US
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Telephone | 901-334-8615
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Fax |
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Provider Business Mailing Address
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Address Line | 7193 SWINNEA RD STE A
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6351
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Country | US
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Telephone | 662-470-6424
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Fax | 662-470-6431
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Authorized Official
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Title or Position | OWNER
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Name | LAKRYSTAL NEWSON
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Credential |
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Telephone | 901-334-8615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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