=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255322152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESYS HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6363 CENTER DR SUITE 201
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-961-5243
-----------------------------------------------------
Fax | 757-961-5253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6363 CENTER DR SUITE 201
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-961-5243
-----------------------------------------------------
Fax | 757-961-5253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MS. MARIA GOLDLYNN NANKIL
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 757-961-5243
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 04-241
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------