Provider Demographics
NPI:1710314331
Name:GENA'S RETIREMENT HOME
Entity Type:Organization
Organization Name:GENA'S RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKBERSINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-452-4416
Mailing Address - Street 1:2233 NW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3003
Mailing Address - Country:US
Mailing Address - Phone:954-733-9614
Mailing Address - Fax:954-733-9614
Practice Address - Street 1:2233 NW 56 AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-452-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL49733104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140321400Medicaid