Healthcare Provider Details

I. General information

NPI: 1184324634
Provider Name (Legal Business Name): GENESIS HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE STE 550
ALBUQUERQUE NM
87112-1273
US

IV. Provider business mailing address

8500 MENAUL BLVD NE STE 550
ALBUQUERQUE NM
87112-1273
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-9646
  • Fax:
Mailing address:
  • Phone: 505-593-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LEO NWAOKWU
Title or Position: OWNER/VP
Credential:
Phone: 512-287-0444