Provider Demographics
NPI:1639314529
Name:ROCKY GENOVESE INC.
Entity Type:Organization
Organization Name:ROCKY GENOVESE INC.
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENOVESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-556-9999
Mailing Address - Street 1:3820 M 139
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8657
Mailing Address - Country:US
Mailing Address - Phone:269-556-9999
Mailing Address - Fax:269-428-0359
Practice Address - Street 1:3820 M 139
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-556-9999
Practice Address - Fax:269-428-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care