Provider Demographics
NPI:1386159648
Name:GENESIS HOME HEALTH SERVICES, INC.- PCA
Entity type:Organization
Organization Name:GENESIS HOME HEALTH SERVICES, INC.- PCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUERUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGUBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-753-7626
Mailing Address - Street 1:2620 RUBY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-1638
Mailing Address - Country:US
Mailing Address - Phone:775-753-7626
Mailing Address - Fax:
Practice Address - Street 1:2620 RUBY VISTA DR
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-1638
Practice Address - Country:US
Practice Address - Phone:775-753-7626
Practice Address - Fax:775-753-7626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HOME HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV173342000194Medicaid