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General NPI Number Information
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NPI Number | 1477944759
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Entity Type | Organization
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Legal Business Name | GENESIS COMMUNITY & FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 2104 NORTH AVE
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City | RICHMOND
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State | VA
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Zip | 23222-4323
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Country | US
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Telephone | 804-721-8616
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 NORTH AVE
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City | RICHMOND
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State | VA
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Zip | 23222-4323
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Country | US
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Telephone | 804-721-8616
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DANIELL LANCASTER
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Credential | MS QMHP
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Telephone | 804-721-8616
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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 | S434108-9
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | S434108-9
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | S434108-9
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License Number State | VA
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