Provider Demographics
NPI:1164079943
Name:GENMAR'S HOME CARE
Entity Type:Organization
Organization Name:GENMAR'S HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VIRGEN
Authorized Official - Last Name:SANTAELLA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:813-679-9469
Mailing Address - Street 1:4784 HICKORY STREAM LN
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-7914
Mailing Address - Country:US
Mailing Address - Phone:813-679-9469
Mailing Address - Fax:863-943-5201
Practice Address - Street 1:4784 HICKORY STREAM LN
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:FL
Practice Address - Zip Code:33860-7914
Practice Address - Country:US
Practice Address - Phone:813-679-9469
Practice Address - Fax:863-943-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1194203471Medicaid