Provider Demographics
NPI:1417372301
Name:GENESIS GERIATRICCARE AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:GENESIS GERIATRICCARE AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHUNTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-201-1848
Mailing Address - Street 1:110 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6129
Mailing Address - Country:US
Mailing Address - Phone:979-297-3802
Mailing Address - Fax:979-529-2100
Practice Address - Street 1:110 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6129
Practice Address - Country:US
Practice Address - Phone:979-297-3802
Practice Address - Fax:979-529-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health