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General NPI Number Information
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NPI Number | 1538790753
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH AND LONGEVITY, INC.
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 3501 CARRIAGE HILL DR STE B
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City | PARAGOULD
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State | AR
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Zip | 72450-5329
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Country | US
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Telephone | 870-236-2911
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Fax | 870-236-2912
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Provider Business Mailing Address
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Address Line | 3501 CARRIAGE HILL DR STE B
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City | PARAGOULD
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State | AR
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Zip | 72450-5329
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Country | US
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Telephone | 870-236-2911
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Fax | 870-236-2912
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | JESSICA MEGAN DEWITT
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Credential |
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Telephone | 870-926-4738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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