Healthcare Provider Details

I. General information

NPI: 1477944759
Provider Name (Legal Business Name): GENESIS COMMUNITY & FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 NORTH AVE
RICHMOND VA
23222-4323
US

IV. Provider business mailing address

2104 NORTH AVE
RICHMOND VA
23222-4323
US

V. Phone/Fax

Practice location:
  • Phone: 804-721-8616
  • Fax:
Mailing address:
  • Phone: 804-721-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberS434108-9
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberS434108-9
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberS434108-9
License Number StateVA

VIII. Authorized Official

Name: DANIELL LANCASTER
Title or Position: CEO
Credential: MS QMHP
Phone: 804-721-8616