Provider Demographics
NPI:1235126574
Name:CARESERVE INC
Entity Type:Organization
Organization Name:CARESERVE INC
Other - Org Name:GENESIS HEALTH & REHAB MCCONNELSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
Authorized Official - Phone:740-962-3761
Mailing Address - Street 1:4114 N STATE ROUTE 376 NW
Mailing Address - Street 2:
Mailing Address - City:MC CONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-9145
Mailing Address - Country:US
Mailing Address - Phone:740-962-3761
Mailing Address - Fax:740-962-3001
Practice Address - Street 1:4114 N STATE ROUTE 376 NW
Practice Address - Street 2:
Practice Address - City:MC CONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-9145
Practice Address - Country:US
Practice Address - Phone:740-962-3761
Practice Address - Fax:740-962-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0066N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5516758Medicaid
OH365147Medicare ID - Type Unspecified