Provider Demographics
NPI:1659645760
Name:GENESIS HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GENESIS HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUERUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGUBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-753-7626
Mailing Address - Street 1:2620 RUBY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-1638
Mailing Address - Country:US
Mailing Address - Phone:775-753-7626
Mailing Address - Fax:775-753-7627
Practice Address - Street 1:8TH EAST HASKELL
Practice Address - Street 2:SUITE C
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3584
Practice Address - Country:US
Practice Address - Phone:775-625-1002
Practice Address - Fax:775-625-2021
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HOME HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5191HSB-4251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297300OtherMEDICARE PROVIDER NUMBER OR PTAN