Healthcare Provider Details

I. General information

NPI: 1568175347
Provider Name (Legal Business Name): GENESIS PARTNERS II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E STEPHENSON AVE STE C
HARRISON AR
72601-4312
US

IV. Provider business mailing address

324 N 48TH ST
SPRINGDALE AR
72762-3746
US

V. Phone/Fax

Practice location:
  • Phone: 870-751-7512
  • Fax:
Mailing address:
  • Phone: 479-246-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CODY GARRISON
Title or Position: COO
Credential:
Phone: 870-404-9300