Genesis Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

GENESIS HOSPICE, LLC

Practice address

2620 Ruby Vista Dr
Elko, NV 89801-1638

Phone

(775) 753-7626

NPI assigned

Apr 20, 2017

Organization subpart

No

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

Authorized official

Name

Querubin Iguban

Title

President

Phone

(775) 753-7626

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Hospice certification: CCN 291555

Legal name

GENESIS HOSPICE, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 8, 2017

Last certification

Oct 22, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Mar 17, 2016 in NV

Enrollment address

2620 Ruby Vista Dr
Elko, NV 89801-1638

Listed as

Genesis Hospice, LLCCCN 291555

Ownership

For-Profit

Certified

Nov 8, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Celestine Q Hernandez, MD

  • Pediatrics Physician
  • Elko, NV
  • NPI 1689739161

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 2

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

• Erica Kapua

  • Personal Care Attendant
  • Elko, NV
  • NPI 1417456435
  NPD
• Celestine Q Hernandez, MD

  • Pediatrics Physician
  • Elko, NV
  • NPI 1689739161
  NPD (past)

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

{
    "created_epoch": "1492646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1902330574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 RUBY VISTA DR",
            "city": "ELKO",
            "state": "NV",
            "postal_code": "898011638",
            "telephone_number": "775-753-7626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 RUBY VISTA DR",
            "city": "ELKO",
            "state": "NV",
            "postal_code": "898011638",
            "telephone_number": "775-753-7626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-20",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "IGUBAN",
        "authorized_official_first_name": "QUERUBIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "775-753-7626"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Wayne Garrison, R.P.T
• Michelle Lenore Gates, MA, MHC-I
• Andrew Lawrence Geisler, MD
• Genesis Home Health Services, Inc.
• Genesis Home Health Services, Inc.- Pca
• Deborah Lynn Gentry
• George a Winch Jr MD PC
• George a Winch Jr MD PC
• Melissa Brooke Gerber, RN
• Sophia Gibson

• Community Based Hospice Care Agency in Elko, NV
• Providers in Elko, NV by specialty
• Community Based Hospice Care Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.