Provider Demographics
NPI:1205004835
Name:GENESIS HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MULCRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-662-8172
Mailing Address - Street 1:6659 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE I & J
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5714
Mailing Address - Country:US
Mailing Address - Phone:770-662-8172
Mailing Address - Fax:770-662-8173
Practice Address - Street 1:6659 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE I & J
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5714
Practice Address - Country:US
Practice Address - Phone:770-662-8172
Practice Address - Fax:770-662-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-17
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5447830001Medicare NSC