Provider Demographics
NPI:1437335627
Name:GENESIS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:GENESIS HEALTHCARE, LLC
Other - Org Name:ORIGIN HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-672-3949
Mailing Address - Street 1:441 APOLLO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2281
Mailing Address - Country:US
Mailing Address - Phone:813-672-3949
Mailing Address - Fax:813-672-3973
Practice Address - Street 1:441 APOLLO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2281
Practice Address - Country:US
Practice Address - Phone:813-672-3949
Practice Address - Fax:813-672-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109060Medicare UPIN