Provider Demographics
NPI:1861490575
Name:GENESIS HOMECARE, INC.
Entity Type:Organization
Organization Name:GENESIS HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-509-3374
Mailing Address - Street 1:116 E HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5155
Mailing Address - Country:US
Mailing Address - Phone:903-509-3374
Mailing Address - Fax:903-509-3380
Practice Address - Street 1:116 E HERITAGE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5155
Practice Address - Country:US
Practice Address - Phone:903-509-3374
Practice Address - Fax:903-509-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002424251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH9404OtherBLUE CROSS/BLUE SHIELD TX
TXHH9404OtherBLUE CROSS/BLUE SHIELD TX