Provider Demographics
NPI:1164908794
Name:GENESIS 365 CARE LLC
Entity Type:Organization
Organization Name:GENESIS 365 CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-825-0717
Mailing Address - Street 1:114 FULLER ST # 1
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3735
Mailing Address - Country:US
Mailing Address - Phone:617-825-0717
Mailing Address - Fax:
Practice Address - Street 1:114 FULLER ST # 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124
Practice Address - Country:US
Practice Address - Phone:617-825-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty