Provider Demographics
NPI:1407587017
Name:GENESIS SERVICES, LLC
Entity Type:Organization
Organization Name:GENESIS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-975-5201
Mailing Address - Street 1:3200 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1513
Mailing Address - Country:US
Mailing Address - Phone:718-601-0200
Mailing Address - Fax:718-601-0201
Practice Address - Street 1:3200 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1513
Practice Address - Country:US
Practice Address - Phone:718-601-0200
Practice Address - Fax:718-601-0201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment