Genesis Home Health Services, Inc.
Organization Active NPI Home Health Agency · Ely, NV
NPI 1366786162 · NPPES record last updated Jan 24, 2013
Key facts
- NPI
- 1366786162
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 7570HSB-0 (NV)
- Legal business name
- GENESIS HOME HEALTH SERVICES, INC.
- Practice address
- 1500 Avenue F
Suite D
Ely, NV 89301-3506 - Phone
- (775) 289-2226
- NPI assigned
- Nov 16, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- GENESIS HOME HEALTH SERVICES, INC.
Authorized official
- Name
- Querubin Iguban
- Title
- President and Ceo
- Phone
- (775) 753-7626
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Practitioners 1
Affiliated clinicians 8
-
Suzette Axelgard, FNP-C
-
Roxanne G Bybee, APRN
-
Yun Namkung, MD
-
Gary M Seigel, M.D.
-
Clement J Strumillo, D.O.
-
Nasir Uddin, M.D.
-
Ha Viet Vu, MD
Medicare Care Compare: Home health agency
- Listed as
- Genesis Home Health Services, Inc
- Overall star rating
- ★★★★★ 4.5 of 5
- Ownership
- Proprietary
- Certified
- Jul 15, 2013
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
Home health agency certification: CCN 297205
- Legal name
- GENESIS HOME HEALTH SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jul 15, 2013
- Last certification
- May 22, 2019
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jun 14, 2004 in NV
- Enrollment address
- 705 Avenue K
Ste C
Ely, NV 89301-2701
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Querubin Iguban |
5% Or Greater Direct Ownership Interest | Jun 14, 2004 | 50% |
| Corporate Officer |
Jun 14, 2004 | 50% | |
| W-2 Managing Employee |
Jun 14, 2004 | 50% | |
| Operational/Managerial Control |
Jun 14, 2004 | 50% | |
| Celestine Q Hernandez |
5% Or Greater Direct Ownership Interest | Jun 14, 2004 | 50% |
| Corporate Officer |
Jun 14, 2004 | 50% | |
| Corporate Director |
Jun 14, 2004 | 50% | |
| W-2 Managing Employee |
Jun 14, 2004 | 50% | |
| Operational/Managerial Control |
Jun 14, 2004 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121204000010 | NV | Part a Provider - Home Health Agency | 3173580776 | Practice locations: Ely, NV |
National Provider Directory
- Tax ID family
- Genesis Home Health Services Inc- Pca
- Part of
- Genesis Home Health Services Inc- Pca
Locations
1500 Avenue F
Ste D
Ely, NV 89301
Phone (775) 289-2002
705 Avenue K
Ste C
Ely, NV 89301
Phone (775) 289-2226
8 E Haskell St
Ste C
Winnemucca, NV 89445
Phone (775) 625-1002
400 W 4th St
Winnemucca, NV 89445
Phone (775) 625-1002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 7570HSB-0 | NV | Yes |
Addresses
Primary practice location
1500 Avenue F
Suite D
Ely, NV 89301-3506
Mailing address
2620 Ruby Vista Drive
Elko, NV 89801-3764
Phone (775) 753-7626
Other providers in Ely, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.