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General NPI Number Information
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NPI Number | 1982326898
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Entity Type | Organization
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Legal Business Name | GENESIS ADULT ACTIVITY CENTER
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 930 MURPHY RD STE B
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City | STAFFORD
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State | TX
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Zip | 77477-5976
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Country | US
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Telephone | 183-236-8305
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Fax | 281-969-7776
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Provider Business Mailing Address
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Address Line | 930 MURPHY RD STE B
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City | STAFFORD
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State | TX
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Zip | 77477-5976
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Country | US
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Telephone | 832-368-3057
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Fax | 281-969-7776
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Authorized Official
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Title or Position | OWNER/ DIRECTOR
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Name | PAMELA CORTEZ WASHINGTON
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Credential |
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Telephone | 832-368-3057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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