MEDICARE: GENESIS GARDENS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1235657008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS GARDENS, INC.

Provider Business Mailing Address
First Line	:	8011 SPLITRAIL CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4488
Country	:	US
Telephone Number	:	682-232-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-5008
Country	:	US
Telephone Number	:	682-777-0277
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK M THOMAS
Credential	:
Telephone Number	:	682-232-7320

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	08/31/2017

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Directions to “GENESIS GARDENS, INC. ” Practice Location

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