Healthcare Provider Details

I. General information

NPI: 1386268217
Provider Name (Legal Business Name): GENESIS HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2020
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 8TH AVE STE B8
GAINESVILLE FL
32601-5089
US

IV. Provider business mailing address

901 NW 8TH AVE STE B3
GAINESVILLE FL
32601-5089
US

V. Phone/Fax

Practice location:
  • Phone: 352-226-4876
  • Fax: 352-557-0250
Mailing address:
  • Phone: 352-226-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAIVELLE O SPEED-STRONG
Title or Position: OWNER
Credential:
Phone: 352-226-4876