Provider Demographics
NPI:1053659490
Name:GENESIS HEALTH CARE
Entity Type:Organization
Organization Name:GENESIS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:MS
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:THERAPIST ASSISTANT
Authorized Official - Phone:270-625-2944
Mailing Address - Street 1:11548 DAWSON ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445
Mailing Address - Country:US
Mailing Address - Phone:270-625-2944
Mailing Address - Fax:270-443-9407
Practice Address - Street 1:501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-0749
Practice Address - Country:US
Practice Address - Phone:270-538-5440
Practice Address - Fax:270-443-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA2305314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility