Provider Demographics
NPI:1275773996
Name:GENESIS HEALTH CARE
Entity Type:Organization
Organization Name:GENESIS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-226-1280
Mailing Address - Street 1:101 E RANDOL MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5800
Mailing Address - Country:US
Mailing Address - Phone:817-226-1280
Mailing Address - Fax:817-226-1290
Practice Address - Street 1:101 E RANDOL MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5800
Practice Address - Country:US
Practice Address - Phone:817-226-1280
Practice Address - Fax:817-226-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-21
Last Update Date:2009-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility