Provider Demographics
NPI:1043995582
Name:JENESIS WELLNESS
Entity Type:Organization
Organization Name:JENESIS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:130-169-3083
Mailing Address - Street 1:903 SERO ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-6082
Mailing Address - Country:US
Mailing Address - Phone:130-169-3083
Mailing Address - Fax:
Practice Address - Street 1:903 SERO ESTATES DR
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-6082
Practice Address - Country:US
Practice Address - Phone:130-169-3083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care