Provider Demographics
NPI:1396396792
Name:GENESIS 2 NATURALS LLC
Entity Type:Organization
Organization Name:GENESIS 2 NATURALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:PERRYMAN
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-832-5066
Mailing Address - Street 1:1746 E SILVER STAR RD STE 121
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7014
Mailing Address - Country:US
Mailing Address - Phone:407-832-5066
Mailing Address - Fax:
Practice Address - Street 1:1746 E SILVER STAR RD STE 121
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-7014
Practice Address - Country:US
Practice Address - Phone:407-832-5066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty