Provider Demographics
NPI:1033414776
Name:GENESIS HEALTHCARE
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELNYK-PRYBYLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA;CCC-SLP
Authorized Official - Phone:860-229-0336
Mailing Address - Street 1:50 PULASKI ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-3565
Mailing Address - Country:US
Mailing Address - Phone:860-229-0336
Mailing Address - Fax:
Practice Address - Street 1:50 PULASKI ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3565
Practice Address - Country:US
Practice Address - Phone:860-229-0336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003246314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility