1568757334 NPI number — GENESYS HEALTH ENTERPRISES, INC.

Table of content: (NPI 1568757334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568757334 NPI number — GENESYS HEALTH ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESYS HEALTH ENTERPRISES, INC.
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:
6
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:
1568757334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 HEALTH PARK BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-9936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-603-8900
Provider Business Mailing Address Fax Number:
810-606-5255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8220 S. SAGINAW
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-694-4391
Provider Business Practice Location Address Fax Number:
810-694-4674
Provider Enumeration Date:
06/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMAN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
810-606-7282

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01002735 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1583785 TYPE 87 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540B518880 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01002744 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0981305 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540B518680 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 540B50435 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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