Provider Demographics
NPI:1609254085
Name:GENBCORP HEALTH CARE CONSULTING, LLC
Entity Type:Organization
Organization Name:GENBCORP HEALTH CARE CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMAY
Authorized Official - Middle Name:RICHARDSON
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-374-1942
Mailing Address - Street 1:6515 CHAPARRAL LN STE 2
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3107
Mailing Address - Country:US
Mailing Address - Phone:404-374-1942
Mailing Address - Fax:888-395-9458
Practice Address - Street 1:6515 CHAPARRAL LN STE 2
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3107
Practice Address - Country:US
Practice Address - Phone:404-374-1942
Practice Address - Fax:888-395-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN078647251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management