Provider Demographics
NPI:1447611801
Name:FLAGLER BEACH HOMECARE
Entity Type:Organization
Organization Name:FLAGLER BEACH HOMECARE
Other - Org Name:GENESIS MC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SNEAD
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:386-338-2072
Mailing Address - Street 1:1222 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3721
Mailing Address - Country:US
Mailing Address - Phone:386-338-2072
Mailing Address - Fax:
Practice Address - Street 1:1222 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3721
Practice Address - Country:US
Practice Address - Phone:386-338-2072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5181900251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1598167504Medicare UPIN