Provider Demographics
NPI:1568735744
Name:GENESIS
Entity Type:Organization
Organization Name:GENESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IWONNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-851-8000
Mailing Address - Street 1:4329 HAWKSONG PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-5480
Mailing Address - Country:US
Mailing Address - Phone:919-387-0878
Mailing Address - Fax:
Practice Address - Street 1:6590 TRYON RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7052
Practice Address - Country:US
Practice Address - Phone:919-851-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3368314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility