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General NPI Number Information
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NPI Number | 1376831396
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Entity Type | Organization
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Legal Business Name | GENESIS HOME HEALTH LLC
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 625 W BROADWAY AVE
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City | YALE
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State | OK
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Zip | 74085-1503
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Country | US
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Telephone | 918-387-2233
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Fax | 918-387-2233
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Provider Business Mailing Address
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Address Line | PO BOX 66
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City | YALE
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State | OK
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Zip | 74085-0066
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Country | US
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Telephone | 918-387-2233
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Fax | 918-387-2233
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Authorized Official
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Title or Position | CO-OWNER/ADMINISTRATOR
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Name | MRS. KATINA CHARLENE MINNEY
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Credential | BSN, RN, CDE, CFCN
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Telephone | 918-387-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R 75354 N0021646
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License Number State | OK
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