Provider Demographics
NPI:1184324634
Name:GENESIS HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:GENESIS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VP
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAOKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-287-0444
Mailing Address - Street 1:8500 MENAUL BLVD NE STE 550
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1273
Mailing Address - Country:US
Mailing Address - Phone:505-593-3113
Mailing Address - Fax:
Practice Address - Street 1:8500 MENAUL BLVD NE STE 550
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1273
Practice Address - Country:US
Practice Address - Phone:505-814-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health