Healthcare Provider Details

I. General information

NPI: 1154572931
Provider Name (Legal Business Name): NEW GENESIS YOUTH & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 HILLDALE WAY SUITE 23
CHARLOTTE NC
28226-3093
US

IV. Provider business mailing address

3412 HILLDALE WAY SUITE 23
CHARLOTTE NC
28226-3093
US

V. Phone/Fax

Practice location:
  • Phone: 704-543-0023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TARSHIMA T DOWNING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 203-535-9917