# GENESIS LIFE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1528507068
- **Authorized official:** MR. KELVIN M SMITH (ADMINISTRATOR)
- **Authorized official phone:** (337) 936-9197

## Contact information

- **Practice address:** 21089 SOUTH FRONTAGE ROAD, LACASSINE, LA 70650
- **Practice address phone:** (337) 936-9197
- **Practice address fax:** (337) 588-4179
- **Mailing address:** PO BOX 1967, IOWA, LA 70647-1967
- **Mailing address phone:** (337) 936-9197
- **Mailing address fax:** (337) 588-4179

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 276400000X | Substance Use Disorder Rehabilitation Hospital Unit | — | LA | Yes |

## Other

- **Enumeration date:** 02/16/2017
- **Last updated:** 02/16/2017