Provider Demographics
NPI:1154552602
Name:GENESIS HEALTH SERVICES
Entity type:Organization
Organization Name:GENESIS HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA JANE
Authorized Official - Middle Name:QUEJA
Authorized Official - Last Name:SARMIENTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:213-382-8761
Mailing Address - Street 1:2542 WESTERN ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-382-8761
Mailing Address - Fax:213-382-8923
Practice Address - Street 1:2542 W 3RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1929
Practice Address - Country:US
Practice Address - Phone:213-382-8761
Practice Address - Fax:213-382-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health