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General NPI Number Information
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NPI Number | 1750647350
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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 | 04/09/2012
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 931 BALDWIN AVE
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City | NEGAUNEE
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State | MI
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Zip | 49866-1064
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Country | US
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Telephone | 906-235-1911
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Fax |
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Provider Business Mailing Address
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Address Line | 931 BALDWIN AVE
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City | NEGAUNEE
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State | MI
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Zip | 49866-1064
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Country | US
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Telephone | 906-235-1911
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | JILL NICHOLE WIECIECH
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Credential | SLP
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Telephone | 906-204-2555
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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 |
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License Number State |
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