Provider Demographics
NPI:1639106180
Name:GENESIS UNIVERSAL HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:GENESIS UNIVERSAL HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:EKONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-720-0104
Mailing Address - Street 1:2057 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4160
Mailing Address - Country:US
Mailing Address - Phone:810-720-0104
Mailing Address - Fax:
Practice Address - Street 1:4199 DAVISON RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1403
Practice Address - Country:US
Practice Address - Phone:810-744-2331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4405025Medicaid
MI=========OtherDMEPOS