Provider Demographics
NPI:1093481764
Name:GENESIS HOSPICECARE SERVICES, INC.
Entity Type:Organization
Organization Name:GENESIS HOSPICECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-246-5577
Mailing Address - Street 1:2550 W UNION HILLS DR STE 350-303
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5163
Mailing Address - Country:US
Mailing Address - Phone:480-758-2950
Mailing Address - Fax:
Practice Address - Street 1:2550 W UNION HILLS DR STE 350-303
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5163
Practice Address - Country:US
Practice Address - Phone:480-246-5577
Practice Address - Fax:480-246-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based