Provider Demographics
NPI:1881859544
Name:GENESIS CARELINK
Entity Type:Organization
Organization Name:GENESIS CARELINK
Other - Org Name:GENESIS HOSPICE CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-846-0922
Mailing Address - Street 1:6341 HIGHWAY 51 N
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-2476
Mailing Address - Country:US
Mailing Address - Phone:662-393-3414
Mailing Address - Fax:662-393-3474
Practice Address - Street 1:705 E SUNFLOWER ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-1888
Practice Address - Country:US
Practice Address - Phone:666-284-6092
Practice Address - Fax:662-846-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS118251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770306Medicaid
MS251608Medicare UPIN
MS251607Medicare UPIN
MS00770306Medicaid