Provider Demographics
NPI:1407118698
Name:G.H.C. INCORPORATED
Entity Type:Organization
Organization Name:G.H.C. INCORPORATED
Other - Org Name:GENESIS HOME CARELINK ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-846-7412
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-0145
Mailing Address - Country:US
Mailing Address - Phone:662-846-7412
Mailing Address - Fax:662-846-0188
Practice Address - Street 1:548 ROSEMARY RD STE C
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2075
Practice Address - Country:US
Practice Address - Phone:662-846-7412
Practice Address - Fax:662-846-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1554251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization