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General NPI Number Information
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NPI Number | 1427748292
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Entity Type | Organization
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Legal Business Name | GENESIS BEHAVIORAL CLINIC LLC
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 2 N CENTRAL AVE STE 1916
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City | PHOENIX
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State | AZ
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Zip | 85004-2322
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Country | US
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Telephone | 949-771-4943
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Fax |
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Provider Business Mailing Address
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Address Line | 2 N CENTRAL AVE STE 1918
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City | PHOENIX
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State | AZ
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Zip | 85004-2322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOYEUX SHIMA
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Credential |
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Telephone | 717-644-6488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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