Provider Demographics
NPI:1275857732
Name:GENESIS HEALTHCARE MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:401-726-9200
Mailing Address - Street 1:39 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2301
Mailing Address - Country:US
Mailing Address - Phone:401-726-9200
Mailing Address - Fax:
Practice Address - Street 1:39 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2301
Practice Address - Country:US
Practice Address - Phone:401-840-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty