Organization
GENESIS HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE MARIE CHEVALIER (ADMINISTRATOR)
(575) 218-3671
Entity
Organization
Contact information
Practice address
120 W 11TH ST, CLOVIS, NM 88101-5806
(575) 218-3671
Mailing address
2401 N MAIN ST STE D, CLOVIS, NM 88101-3581
(575) 218-3671
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
61712
NM
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12855731
—
NM
05
—
88781038
—
NM
Enumeration date
03/01/2011
Last updated
09/12/2022
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