Provider Demographics
NPI:1467328112
Name:GENESIS PROVIDER SERVICES LLC
Entity type:Organization
Organization Name:GENESIS PROVIDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WENENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OKENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-242-8167
Mailing Address - Street 1:7011 HARWIN DR STE 196
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2121
Mailing Address - Country:US
Mailing Address - Phone:713-242-8167
Mailing Address - Fax:713-242-8167
Practice Address - Street 1:7011 HARWIN DR STE 196
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2121
Practice Address - Country:US
Practice Address - Phone:713-242-8167
Practice Address - Fax:713-242-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health