Organization
GENESIS EXTRACARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE SMITSON (PRESIDENT)
(903) 571-1779
Entity
Organization
Contact information
Practice address
3500 S VINE AVE, TYLER, TX 75701-8541
(972) 571-2422
(903) 509-3380
Mailing address
3500 S VINE AVE, TYLER, TX 75701-8541
(972) 571-2422
(903) 509-3380
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
TX
Other
Enumeration date
10/24/2013
Last updated
10/24/2013
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