Healthcare Provider Details

I. General information

NPI: 1225622376
Provider Name (Legal Business Name): GENESIS HEALTHCARE STAFFING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 ATMORE TER
OCOEE FL
34761-4441
US

IV. Provider business mailing address

3324 ATMORE TER
OCOEE FL
34761-4441
US

V. Phone/Fax

Practice location:
  • Phone: 352-217-9960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKESHA ROSS
Title or Position: MGR
Credential:
Phone: 352-217-9960