Provider Demographics
NPI:1821312810
Name:GENCAE HOUSE OF CARE OF TEXAS LLC
Entity Type:Organization
Organization Name:GENCAE HOUSE OF CARE OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:ELIZA
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:682-518-9252
Mailing Address - Street 1:4604 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8611
Mailing Address - Country:US
Mailing Address - Phone:682-518-9252
Mailing Address - Fax:
Practice Address - Street 1:4604 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8611
Practice Address - Country:US
Practice Address - Phone:682-518-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization