MEDICARE: GENESIS

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	A3594	MD

General Provider Information

NPI Number	:	1487999397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS

Provider Business Mailing Address
First Line	:	15625 WOODLAND POINT RD
Second Line	:
City	:	NEWBURG
State	:	MD
Zip	:	20664-6304
Country	:	US
Telephone Number	:	240-210-4075
Fax Number	:

Provider Business Practice Location Address
First Line	:	15625 WOODLAND POINT RD
Second Line	:
City	:	NEWBURG
State	:	MD
Zip	:	20664-6304
Country	:	US
Telephone Number	:	240-210-4075
Fax Number	:

Authorized Official
Title or Position	:	PTA
Name	:	MISS AMANDA MARTIN
Credential	:
Telephone Number	:	240-210-4075

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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Directions to “GENESIS ” Practice Location

Language	Start Address	Practice Location

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