Provider Demographics
NPI:1922043504
Name:PENINSULA REGIONAL-GENESIS ELDERCARE LLC
Entity Type:Organization
Organization Name:PENINSULA REGIONAL-GENESIS ELDERCARE LLC
Other - Org Name:SALISBURY REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:200 CIVIC AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-4599
Practice Address - Country:US
Practice Address - Phone:410-749-1466
Practice Address - Fax:410-749-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22-005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1039162OtherAETNA-HMO
0004621000OtherAMERIHEALTH
MD086801900Medicaid
ML3OtherCAREFIRST - IND/PPO
ML3OtherCAREFIRST BLUECHOICE
02B2OtherCAREFIRST PROV/INQ#
185308OtherAMERIGROUP
341382OtherUNITED - MAMSI
1039162OtherAETNA-HMO
=========OtherHELIXCARE(MEDSTAR)
=========OtherHNFS-TRICARE
=========OtherMARYLAND PHYSICIAN CARE
02B2OtherCAREFIRST PROV/INQ#
=========OtherAETNA-NON-HMO
=========OtherCAREFIRST - TIN
=========OtherCOVENTRY
=========OtherJOHNS HOPKINS
=========OtherNATIONAL CAPITAL PPO