Genesis Adult Family Home LLC

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

Legal business name

GENESIS ADULT FAMILY HOME LLC

Practice address

3315 W Burgundy CT
Mequon, WI 53092-5202

Phone

(262) 853-1344

NPI assigned

Aug 28, 2023

Organization subpart

No

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

Authorized official

Name

Wanda BooneNPI 1124609045

Title

Director

Phone

(262) 853-1344

Specialties & licenses 4

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wanda Boone

  • Non-emergency Medical Transport (VAN)
  • Mequon, WI
  • NPI 1124609045
  NPD Authorized official

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

{
    "created_epoch": "1693180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1831974955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3315 W BURGUNDY CT",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925202",
            "telephone_number": "262-853-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3315 W BURGUNDY CT",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925202",
            "telephone_number": "262-853-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS ADULT FAMILY HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-28",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "262-853-1344"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eamen Geboy, APNP
• Kevin Gee, MD
• James A Gehl, M.D.
• Mary Beth Geiser, PT
• Kailey Marie Geitner, LCSW
• Genufeet, Inc
• Michael Gerard, MD
• Rachel Gerber
• Mark E German, O.D.
• Gwen Joyce Gettelman, PA-C

• Mental Illness Intermediate Care Facility in Mequon, WI
• Providers in Mequon, WI by specialty
• Mental Illness Intermediate Care Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; 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.