| Organization Name: | GENESIS43 LLC |
| NPI Number: | 1285965004 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SEGUNDO I BALDOVINO (OWNER/OPERATOR) |
| Mailing Address: | 22811 Greater Mack Ave Saint Clair Shores |
| State: | MI US |
| Postal Code: | 480802021 |
| Phone Number: | 5865524300 |
| Fax Number: | 5865524304 |
| NPI Enumeration Date: | 01/18/2010 |
| NPI Last Update Date: | 01/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |