1952459299 NPI number — GENESIS ADULT DAY CARE LLC

Table of content: (NPI 1952459299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952459299 NPI number — GENESIS ADULT DAY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS ADULT DAY CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952459299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENITAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78576-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-583-6967
Provider Business Mailing Address Fax Number:
956-583-0484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6920 W EXPRESSWAY 83
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78572-9558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-583-6967
Provider Business Practice Location Address Fax Number:
956-583-0484
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLIVARES
Authorized Official First Name:
DIAMANTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMIN
Authorized Official Telephone Number:
956-583-6967

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  119209 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)