Provider Demographics
NPI:1811434590
Name:GENESIS C & F HOME CARE OF ARKANSAS
Entity type:Organization
Organization Name:GENESIS C & F HOME CARE OF ARKANSAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-281-5718
Mailing Address - Street 1:1117 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-3854
Mailing Address - Country:US
Mailing Address - Phone:901-281-5718
Mailing Address - Fax:
Practice Address - Street 1:1985 KROGER DR STE 11C
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1771
Practice Address - Country:US
Practice Address - Phone:901-281-5718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR253Z00000XOtherTAXONOMY
ARAR5491OtherLICENSE