Genesis Home Health LLC
Organization Active NPI Home Health Agency · Yale, OK
NPI 1376831396 · NPPES record last updated Sep 11, 2024
Key facts
- NPI
- 1376831396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- R 75354 N0021646 (OK)
- Legal business name
- GENESIS HOME HEALTH LLC
- Practice address
- 625 W Broadway Ave
Yale, OK 74085-1503 - Phone
- (918) 387-2233
- Fax
- (918) 387-2233
- NPI assigned
- Jul 11, 2011
- Organization subpart
- No
Authorized official
- Name
- Mrs. Katina Charlene Minney, BSN, RN, CDE, CFCN
- Title
- Co-Owner/Administrator
- Phone
- (918) 387-2233
Affiliated clinicians 15
-
Courtney Gail Elliot, ARNP
-
Jaime Lyn Griffith, APRN-CFP
-
Lisa Diane Noe, PA
-
Kevin L Oltmanns, M.D.
-
Billy Don Schumpert, D.O.
-
Christopher W Sorrels, M.D.
-
Scott N. Stubbs, M. D.
Medicare Care Compare: Home health agency
- Listed as
- Genesis Home Health LLC
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Proprietary
- Certified
- Apr 26, 2013
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Home health agency certification: CCN 377767
- Legal name
- GENESIS HOME HEALTH LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 26, 2013
- Last certification
- May 17, 2016
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Enrollment address
- 625 W Broadway Ave
Yale, OK 74085-1503
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Katina Minney |
5% Or Greater Direct Ownership Interest | Jan 1, 2017 | 67.5% |
| W-2 Managing Employee | Jun 28, 2011 | 45% | |
| Amanda North |
5% Or Greater Direct Ownership Interest |
Jun 28, 2011 | 45% |
| W-2 Managing Employee | Jun 28, 2011 | 45% | |
| Ramesh Patel |
5% Or Greater Direct Ownership Interest | Jan 1, 2017 | 32.5% |
| W-2 Managing Employee | Sep 12, 2012 | 10% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120925000652 | OK | Part a Provider - Home Health Agency | 1456515535 | Practice locations: Yale, OK |
National Provider Directory
Locations
625 W Broadway Ave
Yale, OK 74085
Phone (918) 387-2233
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | R 75354 N0021646 | OK | Yes |
Addresses
Primary practice location
625 W Broadway Ave
Yale, OK 74085-1503
Mailing address
PO Box 66
Yale, OK 74085-0066
Phone (918) 387-2233
Other providers in Yale, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2024. 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.