=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437879798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS HOME HEALTHCARE, LIMITED LIABILITY COMPANY, JACKSO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2022
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10175 FORTUNE PKWY UNIT 804
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-6751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-204-4325
-----------------------------------------------------
Fax | 844-718-0076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10175 FORTUNE PKWY UNIT 804
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-6751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-641-0500
-----------------------------------------------------
Fax | 844-718-0076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. CLAUDIA CARACO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-204-4325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------