1881859544 NPI number — GENESIS CARELINK

Table of content: (NPI 1881859544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881859544 NPI number — GENESIS CARELINK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS CARELINK
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:
GENESIS HOSPICE CARE
Provider Other Organization Name Type Code:
4
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:
1881859544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6341 HIGHWAY 51 N
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
HORN LAKE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38637-2476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-393-3414
Provider Business Mailing Address Fax Number:
662-393-3474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 E SUNFLOWER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38732-1888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
666-284-6092
Provider Business Practice Location Address Fax Number:
662-846-0115
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
CHARLINE
Authorized Official Middle Name:
BRANDON
Authorized Official Title or Position:
OWNER, ADMINISTRATOR
Authorized Official Telephone Number:
662-846-0922

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  118 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00770306 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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