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General NPI Number Information
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NPI Number | 1770977290
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Entity Type | Organization
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Legal Business Name | GENESIS COMPANION SERVICES LLC
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 6501 ARLINGTON EXPY STE B105
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City | JACKSONVILLE
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State | FL
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Zip | 32211-0810
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Country | US
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Telephone | 904-675-0778
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Fax | 904-212-2591
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Provider Business Mailing Address
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Address Line | 15865 LEXINGTON PARK BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8148
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Country | US
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Telephone | 904-405-5614
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Fax | 904-212-2591
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Authorized Official
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Title or Position | OWNER
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Name | TANISA SCIPPIO
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Credential |
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Telephone | 904-405-5614
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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 | FL
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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