Healthcare Provider Details

I. General information

NPI: 1104394634
Provider Name (Legal Business Name): GENESA HOME HEALTHCARE & COMPANION AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 LINCOLN HWY STE 202
FAIRLESS HILLS PA
19030-1000
US

IV. Provider business mailing address

568 LINDERMAN AVENUE EXT
KINGSTON NY
12401-8602
US

V. Phone/Fax

Practice location:
  • Phone: 845-616-2842
  • Fax: 845-514-2101
Mailing address:
  • Phone: 845-616-2842
  • Fax: 845-514-2101

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: MASSA CORNEH
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 917-570-5063