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NPI Code Detail

MEDICARE: GENESIS COMPANION SERVICES LLC

MEDICARE: GENESIS COMPANION SERVICES 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
1251E00000XHome Health AgencyFL
2251E00000XHome Health Agency
3251C00000XDevelopmentally Disabled Services Day Training Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770977290
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS COMPANION SERVICES LLC
Provider Business Mailing Address
First Line : 15865 LEXINGTON PARK BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-8148
Country : US
Telephone Number : 904-405-5614
Fax Number : 904-212-2591
Provider Business Practice Location Address
First Line : 6501 ARLINGTON EXPY STE B105
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-0810
Country : US
Telephone Number : 904-675-0778
Fax Number : 904-212-2591
Authorized Official
Title or Position : OWNER
Name : TANISA SCIPPIO
Credential :
Telephone Number : 904-405-5614
Provider Enumeration Date : 03/23/2015
Last Update Date : 01/13/2023

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Directions to “GENESIS COMPANION SERVICES LLC ” Practice Location

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