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General NPI Number Information
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NPI Number | 1659683936
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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 | 07/02/2010
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 2511 BENTLEY DR
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City | SALEM
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State | OH
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Zip | 44460-2503
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Country | US
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Telephone | 330-337-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 44755 MIDDLE BEAVER RD
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City | LISBON
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State | OH
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Zip | 44432-9556
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Country | US
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Telephone | 330-424-1504
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Fax |
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Authorized Official
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Title or Position | CERTIFIED OCCUPATIONAL THERAPIS
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Name | MRS. SHIRLEY ANN TICE
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Credential | COTA/L
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Telephone | 330-424-1504
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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 | 1087
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License Number State | OH
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