Provider Demographics
NPI:1992027197
Name:GENESIS HOSPICE CARE, LLC
Entity Type:Organization
Organization Name:GENESIS HOSPICE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-846-0100
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-1888
Mailing Address - Country:US
Mailing Address - Phone:662-846-0100
Mailing Address - Fax:662-846-0833
Practice Address - Street 1:135 BOUNDS ST STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4121
Practice Address - Country:US
Practice Address - Phone:601-321-8812
Practice Address - Fax:601-321-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based