Provider Demographics
NPI:1255771473
Name:GENESYS PEDIATRIC HOME CARE, LLC
Entity type:Organization
Organization Name:GENESYS PEDIATRIC HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:NANKIL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-449-4885
Mailing Address - Street 1:6363 CENTER DR
Mailing Address - Street 2:201
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4103
Mailing Address - Country:US
Mailing Address - Phone:757-449-4885
Mailing Address - Fax:757-961-5253
Practice Address - Street 1:6363 CENTER DR
Practice Address - Street 2:201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4103
Practice Address - Country:US
Practice Address - Phone:757-449-4885
Practice Address - Fax:757-961-5253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health