Provider Demographics
NPI:1437879798
Name:GENESIS HOME HEALTHCARE, LIMITED LIABILITY COMPANY, JACKSONVILLE
Entity Type:Organization
Organization Name:GENESIS HOME HEALTHCARE, LIMITED LIABILITY COMPANY, JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-477-4182
Mailing Address - Street 1:10175 FORTUNE PKWY UNIT 504
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6751
Mailing Address - Country:US
Mailing Address - Phone:813-641-0500
Mailing Address - Fax:844-718-0076
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 504
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6751
Practice Address - Country:US
Practice Address - Phone:813-641-0500
Practice Address - Fax:844-718-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty