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General NPI Number Information
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NPI Number | 1518357763
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Entity Type | Organization
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Legal Business Name | GENESIS
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 1313 ORANGE AVE
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City | SANTA ANA
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State | CA
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Zip | 92707-1323
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Country | US
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Telephone | 714-913-5597
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 ORANGE AVE
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City | SANTA ANA
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State | CA
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Zip | 92707-1323
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Country | US
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Telephone | 714-913-5597
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Fax |
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Authorized Official
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Title or Position | COTA
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Name | SARA ARACELI CALDERON
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Credential |
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Telephone | 714-913-5597
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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 | 2408
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License Number State | CA
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