Provider Demographics
NPI:1073390936
Name:GENNAO LLC
Entity Type:Organization
Organization Name:GENNAO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-912-3000
Mailing Address - Street 1:2000 TOWER OAKS BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4282
Mailing Address - Country:US
Mailing Address - Phone:240-912-3000
Mailing Address - Fax:
Practice Address - Street 1:36650 GRAND RIVER AVE STE 102
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-2919
Practice Address - Country:US
Practice Address - Phone:301-525-5176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing