Healthcare Provider Details

I. General information

NPI: 1437430410
Provider Name (Legal Business Name): GENESIS HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 COUNTRY CLUB DR SUITE D
GREENVILLE NC
27834-6208
US

IV. Provider business mailing address

609 COUNTRY CLUB DR SUITE D
GREENVILLE NC
27834-6208
US

V. Phone/Fax

Practice location:
  • Phone: 252-353-0127
  • Fax: 252-353-0137
Mailing address:
  • Phone: 252-353-0127
  • Fax: 252-353-0137

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

VIII. Authorized Official

Name: WILLIE R. SMITH
Title or Position: OWNER
Credential:
Phone: 252-353-0127