Healthcare Provider Details

I. General information

NPI: 1336270032
Provider Name (Legal Business Name): GENESIS PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25129 THE OLD RD SUITE 207
STEVENSON RANCH CA
91381-2244
US

IV. Provider business mailing address

1732 PALMA DR. SUITE 208
VENTURA CA
93003-5796
US

V. Phone/Fax

Practice location:
  • Phone: 661-260-3078
  • Fax:
Mailing address:
  • Phone: 805-650-3094
  • Fax: 805-650-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number39848775
License Number StateCA

VIII. Authorized Official

Name: MRS. ATHENA NARANJO
Title or Position: CEO/CLINICAL DIRECTOR
Credential: LAADC
Phone: 805-650-3094