MEDICARE: GENESIS HEALTH CARE

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1275773996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS HEALTH CARE

Provider Business Mailing Address
First Line	:	101 E RANDOL MILL RD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5800
Country	:	US
Telephone Number	:	817-226-1280
Fax Number	:	817-226-1290

Provider Business Practice Location Address
First Line	:	101 E RANDOL MILL RD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5800
Country	:	US
Telephone Number	:	817-226-1280
Fax Number	:	817-226-1290

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. EMMANUEL ADETULA
Credential	:
Telephone Number	:	817-226-1280

Provider Enumeration Date	:	02/21/2009
Last Update Date	:	02/21/2009

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Directions to “GENESIS HEALTH CARE ” Practice Location

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