Healthcare Provider Details

I. General information

NPI: 1114919842
Provider Name (Legal Business Name): GENESISCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 RANCHEROS DRIVE
SAN MARCOS CA
92069-3033
US

IV. Provider business mailing address

1300 RANCHEROS DRIVE
SAN MARCOS CA
92069-3033
US

V. Phone/Fax

Practice location:
  • Phone: 760-871-0700
  • Fax: 760-871-0713
Mailing address:
  • Phone: 760-871-0700
  • Fax: 760-871-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number080000548
License Number StateCA

VIII. Authorized Official

Name: MR. MARCUS LAFAYETTE KIMSEY IV
Title or Position: ADMINISTRATOR
Credential:
Phone: 760-871-0700