Provider Demographics
NPI:1477022028
Name:GENESIS HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:GENESIS HEALTH AND WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEGUENS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BATAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-200-4353
Mailing Address - Street 1:348 MIRACLE STRIP PKWY SW STE 16A
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5258
Mailing Address - Country:US
Mailing Address - Phone:850-200-4353
Mailing Address - Fax:850-362-6566
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW STE 16A
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5258
Practice Address - Country:US
Practice Address - Phone:850-200-4353
Practice Address - Fax:850-362-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty