Provider Demographics
NPI:1134523194
Name:GENERIS INTERNATIONAL AMERICA
Entity type:Organization
Organization Name:GENERIS INTERNATIONAL AMERICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDNET
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-312-1987
Mailing Address - Street 1:17 TARKILN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1205
Mailing Address - Country:US
Mailing Address - Phone:617-312-1987
Mailing Address - Fax:
Practice Address - Street 1:17 TARKILN RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1205
Practice Address - Country:US
Practice Address - Phone:617-312-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health