# GENESIS

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

## Provider details

- **NPI number:** 1760785877
- **Authorized official:** MS. LYNN DICKERSON (COTA)
- **Authorized official phone:** (973) 598-9443

## Contact information

- **Practice address:** 57 SOUTH SECOND AVENUE, MINEHILL, NJ 07803
- **Practice address phone:** (973) 543-2500
- **Mailing address:** 57 SOUTH SECOND AVENUE, MINEHILL, NJ 07803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/10/2010
- **Last updated:** 12/10/2010