Provider Demographics
NPI:1134476617
Name:GENESIS II ME
Entity Type:Organization
Organization Name:GENESIS II ME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEA
Authorized Official - Middle Name:COLEMAN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-687-2173
Mailing Address - Street 1:12035 MISTY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-2736
Mailing Address - Country:US
Mailing Address - Phone:281-687-2173
Mailing Address - Fax:281-580-4962
Practice Address - Street 1:12035 MISTY VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-2736
Practice Address - Country:US
Practice Address - Phone:281-687-2173
Practice Address - Fax:281-580-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care