Genesis43 LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

GENESIS43 LLC

Practice address

22811 Greater Mack Ave
Saint Clair Shores, MI 48080-2021

Phone

(586) 552-4300

Fax

(586) 552-4304

NPI assigned

Jan 18, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Segundo I Baldovino

Title

Owner/Operator

Phone

(586) 552-4300

Specialties & licenses 1

Addresses

Other names 1

• ComForcare Home Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1285965004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-552-4300",
            "fax_number": "586-552-4304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-552-4300",
            "fax_number": "586-552-4304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS43 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BALDOVINO",
        "authorized_official_first_name": "SEGUNDO",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "586-552-4300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ComForcare Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amandeep Singh Garcha, M.D
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• Carolyn Rain Gentry, PHD
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• Elizabeth George

• In Home Supportive Care Agency in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• In Home Supportive Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.