Provider Demographics
NPI:1174873319
Name:GENESIS HOME HEALTH LLC
Entity type:Organization
Organization Name:GENESIS HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:MINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-387-2233
Mailing Address - Street 1:110 N D ST
Mailing Address - Street 2:PO BOX 66
Mailing Address - City:YALE
Mailing Address - State:OK
Mailing Address - Zip Code:74085-3554
Mailing Address - Country:US
Mailing Address - Phone:918-387-2233
Mailing Address - Fax:
Practice Address - Street 1:110 N D ST
Practice Address - Street 2:
Practice Address - City:YALE
Practice Address - State:OK
Practice Address - Zip Code:74085-3554
Practice Address - Country:US
Practice Address - Phone:918-387-2233
Practice Address - Fax:888-851-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1376831396251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health