Provider Demographics
NPI:1871631283
Name:GENESIS ENTERPRISES INC
Entity Type:Organization
Organization Name:GENESIS ENTERPRISES INC
Other - Org Name:GENESIS HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:HENDERSON SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-784-3712
Mailing Address - Street 1:350 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1361
Mailing Address - Country:US
Mailing Address - Phone:815-784-3712
Mailing Address - Fax:815-784-4673
Practice Address - Street 1:350 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1361
Practice Address - Country:US
Practice Address - Phone:815-784-5146
Practice Address - Fax:815-784-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0031906315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities