Provider Demographics
NPI:1760684039
Name:GENESIS NATIONAL HEALTHCARE INC
Entity Type:Organization
Organization Name:GENESIS NATIONAL HEALTHCARE INC
Other - Org Name:GENESIS MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN MS
Authorized Official - Phone:713-774-0004
Mailing Address - Street 1:8323 SOUTHWEST FWY STE 505
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1625
Mailing Address - Country:US
Mailing Address - Phone:713-774-0004
Mailing Address - Fax:713-933-0429
Practice Address - Street 1:10811 BISSONNET ST
Practice Address - Street 2:#D4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2151
Practice Address - Country:US
Practice Address - Phone:713-774-0004
Practice Address - Fax:713-774-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0091769332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5825190001Medicare NSC