Provider Demographics
NPI:1922093301
Name:GENESIS ELDERCARE REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:GENESIS ELDERCARE REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SOIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4088
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:C/O AMY NUNEMAKER
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:775 E JOHNSTOWN RD
Practice Address - Street 2:C/O SUNRISE OF GAHANNA
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2115
Practice Address - Country:US
Practice Address - Phone:614-532-5199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH412169915-00OtherBWC PROVIDER NUMBER
OH36-6743Medicare PIN
OH366743Medicare Oscar/Certification