Provider Demographics
NPI:1245485002
Name:GENESIS UNLIMITED RESOURCES ,INC.
Entity type:Organization
Organization Name:GENESIS UNLIMITED RESOURCES ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:MCELVEEN
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-394-1361
Mailing Address - Street 1:3444 KABEL DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-6926
Mailing Address - Country:US
Mailing Address - Phone:504-394-1361
Mailing Address - Fax:504-394-1364
Practice Address - Street 1:2028 BECK ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3506
Practice Address - Country:US
Practice Address - Phone:504-394-1361
Practice Address - Fax:504-394-1364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS UNLIMITED RESOURCES,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X
LA385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA03Medicaid
LA89Medicaid