Healthcare Provider Details

I. General information

NPI: 1477892263
Provider Name (Legal Business Name): GENCARE RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 MENTA ST STE 102
ORLANDO FL
32837-7540
US

IV. Provider business mailing address

12200 MENTA ST STE 102
ORLANDO FL
32837-7540
US

V. Phone/Fax

Practice location:
  • Phone: 407-440-2877
  • Fax: 407-440-2876
Mailing address:
  • Phone: 407-440-2877
  • Fax: 407-440-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12000118734
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number12000118734
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MS. OLIVE GAYE
Title or Position: PRESIDENT
Credential: MBA
Phone: 407-325-8448