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General NPI Number Information
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NPI Number | 1477619690
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Entity Type | Organization
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Legal Business Name | GENESIS FAMILY SUPPORT SERVICES
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 223 E MAGNOLIA AVE
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City | LOUISVILLE
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State | KY
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Zip | 40208-2025
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Country | US
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Telephone | 502-224-7067
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Fax | 502-448-0701
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Provider Business Mailing Address
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Address Line | PO BOX 3183
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City | LOUISVILLE
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State | KY
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Zip | 40201-3183
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Country | US
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Telephone | 502-224-7067
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Fax | 502-448-0701
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DONNA A BURKS
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Credential |
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Telephone | 502-224-7067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 251C00000X
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License Number State | KY
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