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General NPI Number Information
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NPI Number | 1952711608
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH CARE
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Dates
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Enumeration Date | 05/03/2014
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Last Update Date | 05/03/2014
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Provider Practice Location Address
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Address Line | 924 DELANEY CIR APT 102
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City | BRANDON
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State | FL
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Zip | 33511-1943
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Country | US
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Telephone | 941-920-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 924 DELANEY CIR APT 102
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City | BRANDON
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State | FL
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Zip | 33511-1943
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Country | US
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Telephone | 941-920-1778
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST ASSISTANT
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Name | MS. CHRISTEN MARIE CLARK
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Credential | COTA
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Telephone | 941-920-1778
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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 | OTA 12220
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License Number State | FL
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