Organization Name: | GENESIS COMMUNITY RESOURCE CENTER |
NPI Number: | 1013231117 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHANDA RENA EVANS (ADMINISTRATOR) |
Mailing Address: | 11616 Barberry Ct Saint John |
State: | IN US |
Postal Code: | 463739690 |
Phone Number: | 7086546324 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2010 |
NPI Last Update Date: | 03/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |