MEDICARE: GENESIS HOME HEALTH LLC

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	251E00000X	Home Health Agency	R 75354 N0021646	OK

General Provider Information

NPI Number	:	1376831396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 66
Second Line	:
City	:	YALE
State	:	OK
Zip	:	74085-0066
Country	:	US
Telephone Number	:	918-387-2233
Fax Number	:	918-387-2233

Provider Business Practice Location Address
First Line	:	625 W BROADWAY AVE
Second Line	:
City	:	YALE
State	:	OK
Zip	:	74085-1503
Country	:	US
Telephone Number	:	918-387-2233
Fax Number	:	918-387-2233

Authorized Official
Title or Position	:	CO-OWNER/ADMINISTRATOR
Name	:	MRS. KATINA CHARLENE MINNEY
Credential	:	BSN, RN, CDE, CFCN
Telephone Number	:	918-387-2233

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	09/11/2024

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