Provider Demographics
NPI:1508362856
Name:GENESIS HEALTHCARE PRODUCTS INC
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-233-8500
Mailing Address - Street 1:830 E VISTA WAY STE 113
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5216
Mailing Address - Country:US
Mailing Address - Phone:657-233-8500
Mailing Address - Fax:
Practice Address - Street 1:830 E VISTA WAY STE 113
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5216
Practice Address - Country:US
Practice Address - Phone:657-233-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies