Organization Name: | GENESIS II ME |
NPI Number: | 1134476617 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RENEA COLEMAN JACKSON (OWER DIRECTOR) |
Mailing Address: | 12035 Misty Valley Dr Houston |
State: | TX US |
Postal Code: | 770662736 |
Phone Number: | 2816872173 |
Fax Number: | 2815804962 |
NPI Enumeration Date: | 08/14/2012 |
NPI Last Update Date: | 08/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |