Provider Demographics
NPI:1992806202
Name:GENESIS HOSPICE CARE, LLC
Entity type:Organization
Organization Name:GENESIS HOSPICE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-846-0100
Mailing Address - Street 1:563 HWY 6 E.
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-3002
Mailing Address - Country:US
Mailing Address - Phone:662-563-7302
Mailing Address - Fax:662-563-6362
Practice Address - Street 1:563 HWY 6 E.
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3002
Practice Address - Country:US
Practice Address - Phone:662-563-7302
Practice Address - Fax:662-563-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04788594Medicaid
MS25-1608Medicare ID - Type Unspecified
MS04788594Medicaid
MSGEN201Medicare PIN