Provider Demographics
NPI:1528349156
Name:GENESIS HEALTHCARE SYSTEMS LLC
Entity type:Organization
Organization Name:GENESIS HEALTHCARE SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTS
Authorized Official - Prefix:MISS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WYCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-515-9129
Mailing Address - Street 1:P. O. BOX 23362
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422
Mailing Address - Country:US
Mailing Address - Phone:770-820-6702
Mailing Address - Fax:
Practice Address - Street 1:1885 LELAND DRIVE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067
Practice Address - Country:US
Practice Address - Phone:586-646-8612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G700758Medicare PIN