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General NPI Number Information
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NPI Number | 1669906046
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Entity Type | Organization
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Legal Business Name | GENISIS SERVICES, INC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 15201 W MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48235-3717
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Country | US
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Telephone | 248-444-2772
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Fax | 248-681-2832
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Provider Business Mailing Address
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Address Line | 15201 W MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48235-3717
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Country | US
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Telephone | 313-279-3002
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Fax | 313-332-4134
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Authorized Official
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Title or Position | CEO
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Name | SHARJEEL KHAN
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Credential |
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Telephone | 248-444-2772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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