Healthcare Provider Details

I. General information

NPI: 1366746430
Provider Name (Legal Business Name): GENESIS GLOBAL NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10515 W MARKHAM ST # H8
LITTLE ROCK AR
72205-2139
US

IV. Provider business mailing address

10515 W MARKHAM ST # H8
LITTLE ROCK AR
72205-2139
US

V. Phone/Fax

Practice location:
  • Phone: 501-626-6090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberBL00096923
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number00000000
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberBL00096923
License Number StateAR

VIII. Authorized Official

Name: MS. VERLIEA WATSON
Title or Position: PRESIDENT
Credential:
Phone: 501-626-6090