Provider Demographics
NPI:1164847505
Name:GENESIS
Entity Type:Organization
Organization Name:GENESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-658-2843
Mailing Address - Street 1:31 W CHERRY ST
Mailing Address - Street 2:BOX 875
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-1781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 W CHERRY ST
Practice Address - Street 2:BOX 875
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-1781
Practice Address - Country:US
Practice Address - Phone:410-658-2843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006211L314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility