MEDICARE: GENESIS ELDERCARE REHABILITATION SERVICES LLC

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
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1093236291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS ELDERCARE REHABILITATION SERVICES LLC

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:	610-925-4560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 S MISSION ST STE O
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4466
Country	:	US
Telephone Number	:	989-282-0320
Fax Number	:

Authorized Official
Title or Position	:	SVP
Name	:	LOUISE ANN SOIKA
Credential	:
Telephone Number	:	610-925-4088

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	02/14/2018

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