Healthcare Provider Details

I. General information

NPI: 1265603005
Provider Name (Legal Business Name): GENESIS FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910-2920 E OLIVE AVE
FRESNO CA
93701
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: 559-439-5411
Mailing address:
  • Phone: 559-439-5437
  • Fax: 559-439-5411

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 ADMINISTRATOR
Credential: LCSW
Phone: 559-439-5437