Provider Demographics
NPI:1760870570
Name:GENESIS HEALTH CARE
Entity Type:Organization
Organization Name:GENESIS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA/REHAB
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:270-251-3492
Mailing Address - Street 1:1788 STATE ROUTE 2205
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-4504
Mailing Address - Country:US
Mailing Address - Phone:270-251-3492
Mailing Address - Fax:
Practice Address - Street 1:1788 STATE ROUTE 2205
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-4504
Practice Address - Country:US
Practice Address - Phone:270-251-3492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02381314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility