Basic Information
| Provider Information | |||||||||
| NPI: | 1316064017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERAL HEALTHCARE RESOURCES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 543 PORT DR | ||||||||
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| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461231237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174311032 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008794471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HMIELEWSKI | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | MISTY DAWN | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPY ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 8008794471 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 32000636A | IN | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 32000636A | 01 | IN | CERTIFICATION | OTHER |