Healthcare Provider Details

I. General information

NPI: 1982110136
Provider Name (Legal Business Name): GENUINE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 12/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAIN STREET
STATE LINE MS
39362
US

IV. Provider business mailing address

1507 HARDY ST STE 201
HATTIESBURG MS
39401-4978
US

V. Phone/Fax

Practice location:
  • Phone: 601-410-5836
  • Fax: 888-449-9560
Mailing address:
  • Phone: 601-410-5836
  • Fax: 888-449-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: LATONYA HAILES
Title or Position: OWNER
Credential:
Phone: 601-410-5836