NPIMap

Organization Active NPI

Peninsula Regional/Genesis Eldercare LLC

  • Physical Therapist
  • Salisbury, MD
National Provider Identifier
1629425889
Registry record updated Sep 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22005 Issued in MD
Legal business name
PENINSULA REGIONAL/GENESIS ELDERCARE LLC
Practice address
200 Civic Ave
Salisbury, MD 21804-4599
Phone
(410) 749-1466
NPI assigned
May 18, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael T. Berg
Title
Assistant Secretary
Phone
(505) 468-4752

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 22005 MD Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 22005 MD

Addresses

Primary practice location

200 Civic Ave
Salisbury, MD 21804-4599

Mailing address

200 Civic Ave
Salisbury, MD 21804-4599
Phone (410) 749-1466

Other identifiers 1

IdentifierTypeStateIssuer
300206300MedicaidMD

Other names 1

  • Salisbury Rehabilitation & Nursing Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505260800000",
    "number": "1629425889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CIVIC AVE",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218044599",
            "telephone_number": "410-749-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CIVIC AVE",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218044599",
            "telephone_number": "410-749-1466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA REGIONAL/GENESIS ELDERCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-18",
        "last_updated": "2017-09-13",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "22005",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "22005",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300206300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salisbury Rehabilitation & Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.