Healthcare Provider Details

I. General information

NPI: 1851005557
Provider Name (Legal Business Name): NEW GENESIS HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S QUEEN ST
DOVER DE
19904-3565
US

IV. Provider business mailing address

1155 RIPLEY ST APT 715
SILVER SPRING MD
20910-7456
US

V. Phone/Fax

Practice location:
  • Phone: 301-938-3750
  • Fax:
Mailing address:
  • Phone: 301-938-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGES WILLIAM NTEMI
Title or Position: CEO
Credential:
Phone: 301-938-3750