MEDICARE: GENESIS FAMILY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1386815520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS FAMILY CENTER

Provider Business Mailing Address
First Line	:	7475 N PALM AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-5763
Country	:	US
Telephone Number	:	559-439-5437
Fax Number	:	559-439-5411

Provider Business Practice Location Address
First Line	:	2920 E OLIVE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93701-1223
Country	:	US
Telephone Number	:	559-439-5437
Fax Number	:	559-439-5411

Authorized Official
Title or Position	:	DEPUTY ADMINISTRATOR
Name	:	MS. CAROL DELA TORRE
Credential	:	LCSW
Telephone Number	:	559-439-5437

Provider Enumeration Date	:	03/16/2008
Last Update Date	:	03/16/2008

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