Provider Demographics
NPI:1659664431
Name:GENESIS ELDERCARE
Entity Type:Organization
Organization Name:GENESIS ELDERCARE
Other - Org Name:GENESIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-350-8514
Mailing Address - Street 1:613 HAMMONDS LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 HAMMONDS LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3351
Practice Address - Country:US
Practice Address - Phone:410-350-8514
Practice Address - Fax:410-636-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224Z00000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility