Provider Demographics
NPI:1447696349
Name:GENESIS NURSING AGENCY LLC
Entity type:Organization
Organization Name:GENESIS NURSING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERESIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-371-0934
Mailing Address - Street 1:509 W. LIBRA DR.
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5771
Mailing Address - Country:US
Mailing Address - Phone:254-634-1003
Mailing Address - Fax:254-634-1005
Practice Address - Street 1:509 W. LIBRA DR.
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5771
Practice Address - Country:US
Practice Address - Phone:254-634-1003
Practice Address - Fax:254-634-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health