Provider Demographics
NPI:1659340149
Name:GENESIS HOME HEALTH INC
Entity Type:Organization
Organization Name:GENESIS HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-757-5999
Mailing Address - Street 1:1175 NE 125TH ST STE 618
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5013
Mailing Address - Country:US
Mailing Address - Phone:305-757-5999
Mailing Address - Fax:
Practice Address - Street 1:1175 NE 125TH ST STE 618
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5013
Practice Address - Country:US
Practice Address - Phone:305-757-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL215630951251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650424800Medicaid
FL010494600Medicaid
FL650424800Medicaid