Provider Demographics
NPI:1902405707
Name:GENESIS HOSPICE INC
Entity Type:Organization
Organization Name:GENESIS HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-266-1161
Mailing Address - Street 1:905 S LAKE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2436
Mailing Address - Country:US
Mailing Address - Phone:747-266-1161
Mailing Address - Fax:
Practice Address - Street 1:905 S LAKE ST STE 203
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2436
Practice Address - Country:US
Practice Address - Phone:747-266-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based