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General NPI Number Information
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NPI Number | 1487959615
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Entity Type | Organization
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Legal Business Name | GENESIS ASSISTED LIVING FACILITY, INC
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 1510 SW 68 AVE
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068
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Country | US
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Telephone | 954-971-0246
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 SW 68 AVE
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068
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Country | US
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Telephone | 954-971-0246
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | PRISCILLA MOWATT
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Credential |
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Telephone | 954-971-0246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 11025
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License Number State | FL
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