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General NPI Number Information
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NPI Number | 1164871364
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Entity Type | Organization
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Legal Business Name | GENYSIS RESTORATION, INC.
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 27801 EUCLID AVE SUITE 458
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City | EUCLID
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State | OH
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Zip | 44132-3549
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Country | US
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Telephone | 216-299-8789
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Fax |
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Provider Business Mailing Address
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Address Line | 27801 EUCLID AVENUE SUITE 458
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City | EUCLID
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State | OH
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Zip | 44132
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Country | US
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Telephone | 216-299-8789
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Fax |
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Authorized Official
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Title or Position | PASTORAL COUNSELOR
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Name | MS. ETHEL YVONNE MIDDLEBROOKS
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Credential | MAPC
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Telephone | 216-299-8789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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