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General NPI Number Information
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NPI Number | 1558648998
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTHCARE, INC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 2605 WOODLAWN RD STE 1
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City | STERLING
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State | IL
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Zip | 61081-4174
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Country | US
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Telephone | 815-625-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 2605 WOODLAWN RD STE 1
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City | STERLING
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State | IL
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Zip | 61081-4174
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Country | US
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Telephone | 815-625-1115
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JUDITY SKATES
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Credential | RN
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Telephone | 815-625-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 4000111
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3000126
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License Number State | IL
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