Provider Demographics
NPI:1285671123
Name:GENESIS HEALTH CARE INC
Entity Type:Organization
Organization Name:GENESIS HEALTH CARE INC
Other - Org Name:GENESIS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FARISCAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-424-9020
Mailing Address - Street 1:16910 W 10 MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2900
Mailing Address - Country:US
Mailing Address - Phone:248-424-9020
Mailing Address - Fax:248-281-0735
Practice Address - Street 1:16910 W 10 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2900
Practice Address - Country:US
Practice Address - Phone:248-424-9020
Practice Address - Fax:248-281-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237481Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER