Provider Demographics
NPI:1922070085
Name:GENESYS CONVALESCENT CENTER-GRAND BLANC INC
Entity Type:Organization
Organization Name:GENESYS CONVALESCENT CENTER-GRAND BLANC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-694-1711
Mailing Address - Street 1:8481 HOLLY ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1899
Mailing Address - Country:US
Mailing Address - Phone:810-694-1711
Mailing Address - Fax:810-694-9717
Practice Address - Street 1:8481 HOLLY ROAD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1899
Practice Address - Country:US
Practice Address - Phone:810-694-1711
Practice Address - Fax:810-694-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI254190314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1009706OtherHEALTHPLUS OF MICHIGAN
MI2152208Medicaid
09706OtherBLUE CROSS OF MICHIGAN
MI2152208Medicaid