Provider Demographics
NPI:1699900100
Name:GENCARE, LLC
Entity type:Organization
Organization Name:GENCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:573-701-9191
Mailing Address - Street 1:200 W 1ST ST STE 192
Mailing Address - Street 2:SUITE 192
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-2521
Mailing Address - Country:US
Mailing Address - Phone:573-701-9191
Mailing Address - Fax:
Practice Address - Street 1:200 W 1ST ST STE 192
Practice Address - Street 2:SUITE 192
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2521
Practice Address - Country:US
Practice Address - Phone:573-701-9191
Practice Address - Fax:573-701-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies