Healthcare Provider Details

I. General information

NPI: 1851510507
Provider Name (Legal Business Name): GENESIS PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 PALMA DR STE 208
VENTURA CA
93003-5796
US

IV. Provider business mailing address

1732 PALMA DR STE 208
VENTURA CA
93003-5796
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number560032AP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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