Healthcare Provider Details

I. General information

NPI: 1467766683
Provider Name (Legal Business Name): GENESIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 NORTH DR
MT PLEASANT MI
48858-3200
US

IV. Provider business mailing address

2611A LYNDALE AVE
MT PLEASANT MI
48858-6010
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-6027
  • Fax:
Mailing address:
  • Phone: 989-213-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER LYNN LINDOW
Title or Position: PROGRAM MANAGER
Credential: PTA,PM
Phone: 989-772-2957