Healthcare Provider Details

I. General information

NPI: 1225294309
Provider Name (Legal Business Name): GENESIS FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 N PALM AVE STE 107
FRESNO CA
93711-5763
US

IV. Provider business mailing address

7475 N PALM AVE STE 107
FRESNO CA
93711-5763
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax:
Mailing address:
  • Phone: 559-439-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROL DELA TORRE
Title or Position: DEPUTY DIRECTOR
Credential: LCSW
Phone: 559-439-5437