Healthcare Provider Details

I. General information

NPI: 1437879798
Provider Name (Legal Business Name): GENESIS HOME HEALTHCARE, LIMITED LIABILITY COMPANY, JACKSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 01/31/2025
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 FORTUNE PKWY UNIT 804
JACKSONVILLE FL
32256-6751
US

IV. Provider business mailing address

10175 FORTUNE PKWY UNIT 804
JACKSONVILLE FL
32256-6751
US

V. Phone/Fax

Practice location:
  • Phone: 904-204-4325
  • Fax: 844-718-0076
Mailing address:
  • Phone: 813-641-0500
  • Fax: 844-718-0076

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
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. CLAUDIA CARACO
Title or Position: OWNER
Credential:
Phone: 904-204-4325