Provider Demographics
NPI:1831316355
Name:GENESIS HOME,LTD.
Entity Type:Organization
Organization Name:GENESIS HOME,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLIOTSOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-799-3235
Mailing Address - Street 1:4409 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5228
Mailing Address - Country:US
Mailing Address - Phone:330-799-3235
Mailing Address - Fax:330-799-3235
Practice Address - Street 1:3572 S RACCOON RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9360
Practice Address - Country:US
Practice Address - Phone:330-797-1502
Practice Address - Fax:330-797-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5000877315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities