Healthcare Provider Details

I. General information

NPI: 1467671750
Provider Name (Legal Business Name): GENESIS & VENUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 AUDUBON BLVD
CLEVELAND OH
44104-5328
US

IV. Provider business mailing address

12419 BUCKEYE RD
CLEVELAND OH
44120-2649
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-0841
  • Fax: 216-231-8187
Mailing address:
  • Phone: 216-295-0841
  • Fax: 216-231-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. BEVERLY ANN MOORE
Title or Position: DIRECTOR
Credential:
Phone: 216-421-2389