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General NPI Number Information
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NPI Number | 1104251446
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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 | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 3025 33RD ST S APT 3
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City | LA CROSSE
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State | WI
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Zip | 54601-7777
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Country | US
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Telephone | 507-313-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 33RD ST S APT 3
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City | LA CROSSE
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State | WI
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Zip | 54601-7777
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Country | US
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Telephone | 507-313-8008
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Fax |
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Authorized Official
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Title or Position | CERTIFIED OCCUPATIONAL THERAPY ASST
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Name | MS. ELIZABETH MARIE GILBERTSON
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Credential | COTA
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Telephone | 507-313-8008
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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 | 500927
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License Number State | WI
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