Healthcare Provider Details

I. General information

NPI: 1801088513
Provider Name (Legal Business Name): GENESIS SUBSTANCE ABUSE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 N PALM AVE
FRESNO CA
93711-5763
US

IV. Provider business mailing address

7475 N PALM AVE
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number100043AN
License Number StateCA

VIII. Authorized Official

Name: MR. RONALD HILL
Title or Position: COUNSELOR
Credential: CERTIFICATE
Phone: 559-439-5437