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General NPI Number Information
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NPI Number | 1215441852
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Entity Type | Organization
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Legal Business Name | GENESIS NEW BEGINNING
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 17822 BEACH BLVD STE 278
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7180
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Country | US
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Telephone | 619-277-1240
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Fax |
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Provider Business Mailing Address
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Address Line | 17822 BEACH BLVD STE 278
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7180
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Country | US
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Telephone | 619-277-1240
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINA GOMES
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Credential |
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Telephone | 714-375-3795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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