Healthcare Provider Details

I. General information

NPI: 1811663552
Provider Name (Legal Business Name): GENESIS HEALTH AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 11/05/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13785 RESEARCH BLVD STE 125
AUSTIN TX
78750-1826
US

IV. Provider business mailing address

3122 ARGENTO PL
CEDAR PARK TX
78613-4357
US

V. Phone/Fax

Practice location:
  • Phone: 512-516-3466
  • Fax: 877-554-0690
Mailing address:
  • Phone: 512-516-3466
  • Fax:

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: MR. DANIEL SUKU JEZREEL
Title or Position: PRESIDENT
Credential:
Phone: 512-516-3466