Provider Demographics
NPI:1952711608
Name:GENESIS HEALTH CARE
Entity Type:Organization
Organization Name:GENESIS HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:941-920-1778
Mailing Address - Street 1:924 DELANEY CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-1943
Mailing Address - Country:US
Mailing Address - Phone:941-920-1778
Mailing Address - Fax:
Practice Address - Street 1:924 DELANEY CIR APT 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-1943
Practice Address - Country:US
Practice Address - Phone:941-920-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-03
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 12220314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility