| Organization Name: | GENESIS SUPPORTIVE LIVING SERVICES LLC |
| NPI Number: | 1063744431 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WELLINGTON M WARREN (DIRECTOR) |
| Mailing Address: | 1545 N 7th St Milwaukee |
| State: | WI US |
| Postal Code: | 532052347 |
| Phone Number: | 4145622567 |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2010 |
| NPI Last Update Date: | 04/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |