# GENESIS SPA CREEK CENTER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548480411
- **Authorized official:** MRS. KRISTEN ELIZABETH RAINES MSCCC-SLP (SPEECH PATHOLOGIST)
- **Authorized official phone:** (410) 562-0754

## Contact information

- **Practice address:** 35 MILKSHAKE LN, ANNAPOLIS, MD 21403-1507
- **Practice address phone:** (410) 269-5100
- **Mailing address:** 1108 CATTAIL COMMONS WAY, DENTON, MD 21629-3015
- **Mailing address phone:** (410) 562-0754

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 05390 | MD | Yes |

## Other

- **Enumeration date:** 04/26/2007
- **Last updated:** 08/22/2020