=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710275433
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2011
-----------------------------------------------------
Last Update Date | 07/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6040 HARFORD RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21214-1327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-426-8855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 FITZGERALD CT APT F
-----------------------------------------------------
City | PARKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-562-1552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MARGARET LYNN PRICE
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 410-426-8855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 02003
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------