Healthcare Provider Details

I. General information

NPI: 1992600092
Provider Name (Legal Business Name): GENESIS COMPANION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 W 12TH CT
RIVIERA BEACH FL
33404-6516
US

IV. Provider business mailing address

1581 W 12TH CT
RIVIERA BEACH FL
33404-6516
US

V. Phone/Fax

Practice location:
  • Phone: 561-652-2017
  • Fax:
Mailing address:
  • Phone: 561-652-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE N DRAINE
Title or Position: OWNER
Credential:
Phone: 561-652-2017