Provider Demographics
NPI:1508941923
Name:GENUS HOME CARE, INC.
Entity Type:Organization
Organization Name:GENUS HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JANET
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-981-1821
Mailing Address - Street 1:1476 W. 9TH STREET SUITE B-1
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5743
Mailing Address - Country:US
Mailing Address - Phone:909-981-1821
Mailing Address - Fax:909-981-6528
Practice Address - Street 1:1476 W. 9TH STREET SUITE B-1
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5743
Practice Address - Country:US
Practice Address - Phone:909-981-1821
Practice Address - Fax:909-981-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000820251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08075FMedicaid
CA058075Medicare PIN