Provider Demographics
NPI:1548148588
Name:GENESIS ASSISTED LIVING L.L.C.
Entity type:Organization
Organization Name:GENESIS ASSISTED LIVING L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DJOUDLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-545-6797
Mailing Address - Street 1:5352 ROCKY COAST PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1423
Mailing Address - Country:US
Mailing Address - Phone:941-545-6797
Mailing Address - Fax:
Practice Address - Street 1:14138 CRUTCHFIELD CT FL 34219
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-9408
Practice Address - Country:US
Practice Address - Phone:813-270-4583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances