Basic Information
| Provider Information | |||||||||
| NPI: | 1518239599 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENESYS HOME HEALTH & HOSPICE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GENESYS HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5445 ALI DRIVE | ||||||||
| Address2: | DEPT 600 | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484395195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106038600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5445 ALI DR | ||||||||
| Address2: | DEPT 600 | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484395191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106038600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2012 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | STEVENS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF CONTINUUM OF CARE | ||||||||
| AuthorizedOfficialTelephone: | 8106038690 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 254028 | MI | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | OE04600M | 01 | MI | HEALTH PLUS | OTHER |