Healthcare Provider Details

I. General information

NPI: 1174880033
Provider Name (Legal Business Name): GENCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 WOODBINE
FREDERICKSBURG VA
22407-9211
US

IV. Provider business mailing address

5717 WOODBINE CT
FREDERICKSBURG VA
22407-9211
US

V. Phone/Fax

Practice location:
  • Phone: 540-693-4811
  • Fax: 540-693-4091
Mailing address:
  • Phone: 540-693-4811
  • Fax: 540-693-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. GENEVA COLLINS
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential:
Phone: 540-376-8723