Provider Demographics
NPI:1346957115
Name:GENESIS NEW BEGINNINGS L.L.C.
Entity type:Organization
Organization Name:GENESIS NEW BEGINNINGS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-789-9116
Mailing Address - Street 1:12713 W DESERT ROSE RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-7007
Mailing Address - Country:US
Mailing Address - Phone:216-789-9116
Mailing Address - Fax:
Practice Address - Street 1:12713 W DESERT ROSE RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-7007
Practice Address - Country:US
Practice Address - Phone:216-789-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health