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General NPI Number Information
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NPI Number | 1578795431
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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 | 08/11/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 620 WATER ST
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City | CHARDON
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State | OH
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Zip | 44024-1149
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Country | US
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Telephone | 440-279-4214
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Fax |
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Provider Business Mailing Address
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Address Line | 30310 FORESTGROVE RD
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City | WILLOWICK
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State | OH
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Zip | 44095-4957
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Country | US
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Telephone | 440-278-4271
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Fax |
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Authorized Official
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Title or Position | AREA DIRECTOR
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Name | CAROL ASHDOWN
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Credential | M.A.- CCC-SLP
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Telephone | 440-279-4214
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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 | 9453
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License Number State | OH
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