Provider Demographics
NPI:1376831396
Name:GENESIS HOME HEALTH LLC
Entity type:Organization
Organization Name:GENESIS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:MINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, CDE, CFCN
Authorized Official - Phone:918-387-2233
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:OK
Mailing Address - Zip Code:74085-0066
Mailing Address - Country:US
Mailing Address - Phone:918-387-2233
Mailing Address - Fax:918-387-2233
Practice Address - Street 1:625 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:OK
Practice Address - Zip Code:74085-1503
Practice Address - Country:US
Practice Address - Phone:918-387-2233
Practice Address - Fax:918-387-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 75354 N0021646251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health