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General NPI Number Information
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NPI Number | 1942745088
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Entity Type | Organization
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Legal Business Name | GENESIS DETOX OF BROOKLYN, LLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 449 39TH ST
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City | BROOKLYN
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State | NY
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Zip | 11232-2909
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Country | US
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Telephone | 718-633-4673
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Fax | 929-250-2332
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Provider Business Mailing Address
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Address Line | 449 39TH ST # 6
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City | BROOKLYN
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State | NY
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Zip | 11232-2909
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Country | US
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Telephone | 718-633-4673
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Fax | 929-250-2332
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Authorized Official
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Title or Position | MANAGING PARTNER/CEO
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Name | MR. SAMUEL BENITEZ
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Credential |
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Telephone | 718-633-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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