Provider Demographics
NPI:1568584928
Name:GENESIS HEALTHCARE
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPY MGR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-829-9056
Mailing Address - Street 1:536 UNGER AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2027
Mailing Address - Country:US
Mailing Address - Phone:937-832-3250
Mailing Address - Fax:
Practice Address - Street 1:1390 KING TREE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1401
Practice Address - Country:US
Practice Address - Phone:937-278-0723
Practice Address - Fax:937-276-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 02070313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility