Provider Demographics
NPI:1265295125
Name:GENESIS HEALTHCARE INC
Entity type:Organization
Organization Name:GENESIS HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BOLAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUGBOJA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP PMHNP
Authorized Official - Phone:410-258-0565
Mailing Address - Street 1:127 PITTSTON CIR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1723
Mailing Address - Country:US
Mailing Address - Phone:410-258-0565
Mailing Address - Fax:410-237-6306
Practice Address - Street 1:8509 GLEN MICHAEL LN APT T3
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5227
Practice Address - Country:US
Practice Address - Phone:410-258-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty