Provider Demographics
NPI:1750966206
Name:GENESIS IVDRIPS & WELLNESS LLC
Entity type:Organization
Organization Name:GENESIS IVDRIPS & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:MANKAH
Authorized Official - Last Name:AWUNDAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-246-1070
Mailing Address - Street 1:442 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1246
Mailing Address - Country:US
Mailing Address - Phone:856-246-1070
Mailing Address - Fax:
Practice Address - Street 1:442 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1246
Practice Address - Country:US
Practice Address - Phone:856-246-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion