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General NPI Number Information
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NPI Number | 1922043504
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Entity Type | Organization
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Legal Business Name | PENINSULA REGIONAL-GENESIS ELDERCARE LLC
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 200 CIVIC AVE
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City | SALISBURY
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State | MD
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Zip | 21804-4599
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Country | US
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Telephone | 410-749-1466
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Fax | 410-749-3208
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Provider Business Mailing Address
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Address Line | 101 E STATE ST
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3109
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Country | US
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Telephone | 610-925-4436
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Fax | 610-925-4351
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T. BERG
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Credential |
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Telephone | 505-468-4752
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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 | 22-005
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License Number State | PA
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