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NPI Code Detail

MEDICARE: GENESIS HEALTHCARE CENTER, INC

MEDICARE: GENESIS HEALTHCARE CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility940000173CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1940000173OTHERCALICENSE NUMBER

General Provider Information

NPI Number : 1083935746
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS HEALTHCARE CENTER, INC
Provider Business Mailing Address
First Line : 1201 WALNUT AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-3822
Country : US
Telephone Number : 562-591-7621
Fax Number : 562-591-3292
Provider Business Practice Location Address
First Line : 1201 WALNUT AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-3822
Country : US
Telephone Number : 562-591-7621
Fax Number : 562-591-3292
Authorized Official
Title or Position : PRESIDENT
Name : MR. RANDY L HENRY
Credential :
Telephone Number : 818-888-1616
Provider Enumeration Date : 06/17/2010
Last Update Date : 03/22/2011

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Directions to “GENESIS HEALTHCARE CENTER, INC ” Practice Location

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