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General NPI Number Information
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NPI Number | 1134358872
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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 | 07/02/2009
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 4560 PRINCESS ANNE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7905
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Country | US
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Telephone | 757-495-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 509 SPRING LAKE CRES APT 302
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | LACEY WATFORD
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Credential | MSOTR/L
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Telephone | 757-685-1046
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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 |
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License Number State |
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