Provider Demographics
NPI:1851691646
Name:GENISIS HEALTHCARE
Entity Type:Organization
Organization Name:GENISIS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:201-541-4323
Mailing Address - Street 1:379 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1431
Mailing Address - Country:US
Mailing Address - Phone:908-295-5150
Mailing Address - Fax:
Practice Address - Street 1:101 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3109
Practice Address - Country:US
Practice Address - Phone:610-645-8428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09004100320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities