Provider Demographics
NPI:1407060247
Name:GENESIS HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-412-4863
Mailing Address - Street 1:5932 SHAKERTOWN DR NW
Mailing Address - Street 2:APT. J-9
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-9300
Mailing Address - Country:US
Mailing Address - Phone:330-412-4863
Mailing Address - Fax:
Practice Address - Street 1:800 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1083
Practice Address - Country:US
Practice Address - Phone:330-430-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 3558314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility