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General NPI Number Information
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NPI Number | 1255904231
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Entity Type | Organization
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Legal Business Name | GENESIS I ASSISTED LIVING FACILITY INC.
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 324 MINE RD
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City | MIDWAY
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State | FL
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Zip | 32343-2710
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Country | US
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Telephone | 850-510-1757
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Fax |
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Provider Business Mailing Address
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Address Line | 324 MINE RD
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City | MIDWAY
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State | FL
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Zip | 32343-2710
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Country | US
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Telephone | 850-510-1757
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | TRACY FRANKLIN
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Credential |
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Telephone | 850-510-1757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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