MEDICARE: GENESIS BEHAVIORAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility		WI

General Provider Information

NPI Number	:	1568620466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS BEHAVIORAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 2210
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:	414-777-1570
Fax Number	:

Provider Business Practice Location Address
First Line	:	6737 W WASHINGTON ST
Second Line	:	SUITE 2210
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5647
Country	:	US
Telephone Number	:	414-777-1570
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	SCOTT DAVID HUNTINGTON
Credential	:	MA,LPC,CSAC,ICS
Telephone Number	:	414-588-9062

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	05/28/2008

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