Provider Demographics
NPI:1629828371
Name:GENESIS LOVING CARE LLC
Entity type:Organization
Organization Name:GENESIS LOVING CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:NIKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-406-0774
Mailing Address - Street 1:2682 TUSCARORA TRAIL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6670
Mailing Address - Country:US
Mailing Address - Phone:229-406-0774
Mailing Address - Fax:
Practice Address - Street 1:2682 TUSCARORA TRAIL
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6670
Practice Address - Country:US
Practice Address - Phone:229-406-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health