Healthcare Provider Details

I. General information

NPI: 1639887656
Provider Name (Legal Business Name): GENESIS CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CAMMIE DR
CANDOR NC
27229
US

IV. Provider business mailing address

PO BOX 672
CANDOR NC
27229-0672
US

V. Phone/Fax

Practice location:
  • Phone: 910-571-4536
  • Fax: 910-571-4536
Mailing address:
  • Phone: 910-571-4536
  • Fax: 910-571-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH D BOWDEN
Title or Position: OWNER
Credential:
Phone: 910-571-4536