Organization
GENESIS RESTORE HOME HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID NKWONTA (OWNER)
(651) 233-0937
Entity
Organization
Contact information
Practice address
5665 ARAPAHO RD APT 827, DALLAS, TX 75248-3491
(651) 233-0937
Mailing address
5665 ARAPAHO RD APT 827, DALLAS, TX 75248-3491
(651) 233-0937
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
11/14/2023
Last updated
11/14/2023
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