Provider Demographics
NPI:1821284936
Name:GENESIS FAMILY HEALTHCARE, INC
Entity Type:Organization
Organization Name:GENESIS FAMILY HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-885-1830
Mailing Address - Street 1:4404 NATURAL LAKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 N HAMILTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2600
Practice Address - Country:US
Practice Address - Phone:336-885-1830
Practice Address - Fax:336-885-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1883251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720118672OtherNPI