MEDICARE: GENESIS SCHOOL, INC

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	:	1750548442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS SCHOOL, INC

Provider Business Mailing Address
First Line	:	3800 E 44TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2168
Country	:	US
Telephone Number	:	816-921-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 E 44TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64130-2168
Country	:	US
Telephone Number	:	816-921-0775
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF COUNSELING
Name	:	MRS. TINA GADDY
Credential	:	LCSW
Telephone Number	:	816-245-5128

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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