Healthcare Provider Details

I. General information

NPI: 1164871364
Provider Name (Legal Business Name): GENYSIS RESTORATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27801 EUCLID AVE SUITE 458
EUCLID OH
44132-3549
US

IV. Provider business mailing address

27801 EUCLID AVENUE SUITE 458
EUCLID OH
44132
US

V. Phone/Fax

Practice location:
  • Phone: 216-299-8789
  • Fax:
Mailing address:
  • Phone: 216-299-8789
  • 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: MS. ETHEL YVONNE MIDDLEBROOKS
Title or Position: PASTORAL COUNSELOR
Credential: MAPC
Phone: 216-299-8789