Provider Demographics
NPI:1679840185
Name:GENESIS HOME HEALTH CARE SERVICES OF CENTRAL FLORIDA LLC
Entity Type:Organization
Organization Name:GENESIS HOME HEALTH CARE SERVICES OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-262-8235
Mailing Address - Street 1:5104 N ORANGE BLOSSOM TRL STE 208
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1016
Mailing Address - Country:US
Mailing Address - Phone:321-262-8235
Mailing Address - Fax:407-369-7249
Practice Address - Street 1:5104 N ORANGE BLOSSOM TRL STE 208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1016
Practice Address - Country:US
Practice Address - Phone:321-262-8235
Practice Address - Fax:407-369-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health