Provider Demographics
NPI:1922348077
Name:GENESIS
Entity Type:Organization
Organization Name:GENESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGARISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-652-0282
Mailing Address - Street 1:2932 RAYSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:PA
Mailing Address - Zip Code:16650-7622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 PENNKNOLL RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-6940
Practice Address - Country:US
Practice Address - Phone:814-623-9018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001494314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility