Provider Demographics
NPI:1972928455
Name:GENOMA HOME HEALTH CARE AGENCY, INC.
Entity type:Organization
Organization Name:GENOMA HOME HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-410-5622
Mailing Address - Street 1:1499 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAKE CLARKE SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6050
Mailing Address - Country:US
Mailing Address - Phone:561-410-5622
Mailing Address - Fax:561-410-5621
Practice Address - Street 1:1499 FOREST HILL BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6050
Practice Address - Country:US
Practice Address - Phone:561-410-5622
Practice Address - Fax:561-410-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health