Provider Demographics
NPI:1386872885
Name:GENESIS
Entity type:Organization
Organization Name:GENESIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:BEACHER
Authorized Official - Suffix:I
Authorized Official - Credentials:PTA
Authorized Official - Phone:570-624-3228
Mailing Address - Street 1:124 SCHUYLKILL AVE
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-1337
Mailing Address - Country:US
Mailing Address - Phone:570-462-0345
Mailing Address - Fax:
Practice Address - Street 1:124 SCHUYLKILL AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1337
Practice Address - Country:US
Practice Address - Phone:570-462-0345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000175314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility