Basic Information
| Provider Information | |||||||||
| NPI: | 1033448683 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENESYS HOME HEALTH & HOSPICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3933 BEECHER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107624600 | ||||||||
| FaxNumber: | 8107624110 | ||||||||
| Practice Location | |||||||||
| Address1: | 3933 BEECHER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107624600 | ||||||||
| FaxNumber: | 8107624110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2009 | ||||||||
| LastUpdateDate: | 12/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | STEVENS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8107624600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 772940185 | 05 | MI | MEDICAID |