Provider Demographics
NPI:1952459299
Name:GENESIS ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:GENESIS ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DIAMANTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-6967
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-0497
Mailing Address - Country:US
Mailing Address - Phone:956-583-6967
Mailing Address - Fax:956-583-0484
Practice Address - Street 1:6920 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-9558
Practice Address - Country:US
Practice Address - Phone:956-583-6967
Practice Address - Fax:956-583-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119209251C00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services