1659645760 NPI number — GENESIS HOME HEALTH SERVICES, INC.

Table of content: (NPI 1659645760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659645760 NPI number — GENESIS HOME HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS HOME HEALTH SERVICES, 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:
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:
1659645760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 RUBY VISTA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89801-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-753-7626
Provider Business Mailing Address Fax Number:
775-753-7627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8TH EAST HASKELL
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
WINNEMUCCA
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89445-3584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-625-1002
Provider Business Practice Location Address Fax Number:
775-625-2021
Provider Enumeration Date:
03/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
IGUBAN
Authorized Official First Name:
QUERUBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
775-753-7626

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  5191HSB-4 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 297300 . This is a "MEDICARE PROVIDER NUMBER OR PTAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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