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General NPI Number Information
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NPI Number | 1952518649
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Entity Type | Organization
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Legal Business Name | GENESIS SUBSTANCE ABUSE SERVICES
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 7475 N PALM AVE STE 107
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City | FRESNO
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State | CA
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Zip | 93711-5763
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Country | US
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Telephone | 559-439-5437
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Fax | 559-439-5411
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Provider Business Mailing Address
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Address Line | 7475 N PALM AVE STE 107
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City | FRESNO
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State | CA
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Zip | 93711-5763
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Country | US
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Telephone | 559-439-5437
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Fax | 559-439-5411
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | MISS TONGIA SULLIVAN
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Credential | BA, SWK
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Telephone | 559-439-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number | 100043AN
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License Number State | CA
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