# GENESIS EXTRACARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184052441
- **Authorized official:** MRS. STEPHANIE SMITSON (PRESIDENT)
- **Authorized official phone:** (903) 571-1779

## Contact information

- **Practice address:** 3500 S VINE AVE, TYLER, TX 75701-8541
- **Practice address phone:** (972) 571-2422
- **Practice address fax:** (903) 509-3380
- **Mailing address:** 3500 S VINE AVE, TYLER, TX 75701-8541
- **Mailing address phone:** (972) 571-2422
- **Mailing address fax:** (903) 509-3380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 372600000X | Adult Companion | — | TX | Yes |

## Other

- **Enumeration date:** 10/24/2013
- **Last updated:** 10/24/2013