Healthcare Provider Details

I. General information

NPI: 1659156180
Provider Name (Legal Business Name): GENESIS RECUPERATIVE CARE SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 W STOCKWELL ST
COMPTON CA
90222-3321
US

IV. Provider business mailing address

1036 W STOCKWELL ST
COMPTON CA
90222-3321
US

V. Phone/Fax

Practice location:
  • Phone: 213-352-6038
  • Fax: 323-967-7300
Mailing address:
  • Phone: 213-352-6038
  • Fax: 323-967-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD COLE
Title or Position: CEO
Credential:
Phone: 310-864-2231