MEDICARE: GENESIS GRACE HOME INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	385HR2065X	Child Physical Disabilities Respite Care
2	251E00000X	Home Health Agency
3	251G00000X	Community Based Hospice Care Agency
4	251J00000X	Nursing Care Agency
5	251S00000X	Community/Behavioral Health Agency
6	253Z00000X	In Home Supportive Care Agency
7	310400000X	Assisted Living Facility
8	314000000X	Skilled Nursing Facility
9	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
10	343900000X	Non-emergency Medical Transport (VAN)
11	385H00000X	Respite Care
12	385HR2050X	Respite Care Camp
13	385HR2055X	Child Mental Illness Respite Care
14	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
15	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1942803994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS GRACE HOME INC

Provider Business Mailing Address
First Line	:	442 BROADWAY
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1246
Country	:	US
Telephone Number	:	646-730-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	442 BROADWAY
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1246
Country	:	US
Telephone Number	:	646-730-0249
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVELYN AWUNDAGA
Credential	:
Telephone Number	:	164-673-0024

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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Directions to “GENESIS GRACE HOME INC ” Practice Location

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