MEDICARE: GENCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	371021	MN

General Provider Information

NPI Number	:	1902299134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENCARE LLC

Provider Business Mailing Address
First Line	:	4430 EXCELSIOR BLVD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4814
Country	:	US
Telephone Number	:	952-236-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	4430 EXCELSIOR BLVD
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-4814
Country	:	US
Telephone Number	:	952-236-7527
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MS. DENISE MARIE SCHAEFER
Credential	:
Telephone Number	:	952-236-7527

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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