Provider Demographics
NPI:1740744366
Name:GENESIS HEALTHCARE UNITED STATES
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE UNITED STATES
Other - Org Name:GENESIS HEALTHCARE US
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:ND, PSYD, MFCT
Authorized Official - Phone:800-813-9036
Mailing Address - Street 1:105 MONUMENT PL
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3955
Mailing Address - Country:US
Mailing Address - Phone:800-813-9036
Mailing Address - Fax:866-410-7649
Practice Address - Street 1:105 MONUMENT PL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3955
Practice Address - Country:US
Practice Address - Phone:800-813-9036
Practice Address - Fax:866-410-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty