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General NPI Number Information
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NPI Number | 1861558512
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Entity Type | Organization
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Legal Business Name | RM GENESIS HEALTHCARE
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 4518 W MARKET ST STE A
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City | GREENSBORO
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State | NC
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Zip | 27407-1543
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Country | US
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Telephone | 336-235-4022
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Fax | 336-235-4023
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Provider Business Mailing Address
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Address Line | 4518 W MARKET ST STE A
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City | GREENSBORO
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State | NC
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Zip | 27407-1543
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Country | US
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Telephone | 336-235-4022
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Fax | 336-235-4023
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. ROOSEVELT JOHN SMITH
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Credential | DC
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Telephone | 336-235-4022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2930
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License Number State | NC
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