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General NPI Number Information
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NPI Number | 1831585561
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Entity Type | Organization
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Legal Business Name | GENESIS RECOVERY, INC.
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 18985 HIGHWAY 94
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City | DULZURA
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State | CA
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Zip | 91917-1527
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Country | US
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Telephone | 858-204-7285
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Fax |
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Provider Business Mailing Address
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Address Line | 8030 LA MESA BLVD # 525
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City | LA MESA
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State | CA
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Zip | 91942-0335
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Country | US
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Telephone | 858-204-7285
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Fax | 619-367-9737
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JULIE HAYDEN
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Credential | PSYD
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Telephone | 858-204-7285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 370139AN
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License Number State | CA
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