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General NPI Number Information
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NPI Number | 1104138924
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTHCARE
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 1522 BROOKLINE BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15226-1914
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Country | US
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Telephone | 412-477-3172
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Fax |
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Provider Business Mailing Address
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Address Line | 1522 BROOKLINE BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15226-1914
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Country | US
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Telephone | 412-477-3172
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MR. FREDRICK ANDREW FAUST
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Credential | PTA
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Telephone | 412-477-3172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | TE008531
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License Number State | PA
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