Provider Demographics
NPI:1003348707
Name:JENESYS HOME CARE ATLANTA
Entity Type:Organization
Organization Name:JENESYS HOME CARE ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-420-0566
Mailing Address - Street 1:1403 GREENBRIER PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2876
Mailing Address - Country:US
Mailing Address - Phone:757-420-0566
Mailing Address - Fax:
Practice Address - Street 1:3464 ROXBORO RD NE
Practice Address - Street 2:UNIT 1110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1317
Practice Address - Country:US
Practice Address - Phone:757-419-6153
Practice Address - Fax:757-420-0599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENESYS HOME HEALTH CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245574284Medicaid
VA1841722600Medicaid