Provider Demographics
NPI:1811663552
Name:GENESIS HEALTH AT HOME LLC
Entity type:Organization
Organization Name:GENESIS HEALTH AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SUKU
Authorized Official - Last Name:JEZREEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-516-3466
Mailing Address - Street 1:3122 ARGENTO PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4357
Mailing Address - Country:US
Mailing Address - Phone:512-516-3466
Mailing Address - Fax:
Practice Address - Street 1:13785 RESEARCH BLVD STE 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1826
Practice Address - Country:US
Practice Address - Phone:512-516-3466
Practice Address - Fax:877-554-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care