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Organization
1526 LOMBARD STREET OPERATIONS LLC
Active
Organization
1526 LOMBARD STREET OPERATIONS LLC
Active
Parent organization
GENESIS PA HOLDINGS LLC
Other names
PowerBack Rehabilitation 1526 Lombard Street
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESIS PA HOLDINGS LLC
Authorized official
MICHAEL T BERG (ASSISTANT SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
1526 LOMBARD ST, PHILADELPHIA, PA 19146-1625
(215) 546-6960
(215) 732-7451
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-2009
(610) 347-4098
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
200402
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025711460001
—
PA
Enumeration date
11/28/2007
Last updated
05/03/2021
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