Healthcare Provider Details

I. General information

NPI: 1679416507
Provider Name (Legal Business Name): GENESIS RESIDENTIAL LIVING AND HOME HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 HARRISON ST STE 304
HILLSIDE IL
60162-1905
US

IV. Provider business mailing address

4415 HARRISON ST STE 304
HILLSIDE IL
60162-1905
US

V. Phone/Fax

Practice location:
  • Phone: 262-364-4825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WANDA BROWN
Title or Position: OWNER
Credential:
Phone: 262-364-4825