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General NPI Number Information
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NPI Number | 1447696349
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Entity Type | Organization
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Legal Business Name | GENESIS NURSING AGENCY LLC
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 509 W. LIBRA DR.
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City | KILLEEN
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State | TX
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Zip | 76542-5771
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Country | US
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Telephone | 254-634-1003
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Fax | 254-634-1005
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Provider Business Mailing Address
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Address Line | 509 W. LIBRA DR.
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City | KILLEEN
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State | TX
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Zip | 76542-5771
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Country | US
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Telephone | 254-634-1003
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Fax | 254-634-1005
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Authorized Official
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Title or Position | OWNER
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Name | FERESIE A. ISOME
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Credential |
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Telephone | 254-371-0934
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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 |
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License Number State |
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