Genesis Family Home
Residential Treatment Facility, Emotionally Disturbed Children in Concord, NC. Organization (NPI-2).
NPI number1104044353
StatusActive
Last updated in NPPESJun 13, 2008
Details
- NPI
- 1104044353
- Entity type
- Organization (NPI-2)
- Legal business name
- Genesis Family Home
- Organization subpart
- No
- Enumeration date
- Apr 23, 2007
- Last updated
- Jun 13, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | MHL-013-096 | NC | Yes |
Practice location
484 Cook St NwConcord, NC 28025-4441
Phone 704-793-9593
Mailing address
1036 Branchview DrSuite
Concord, NC 28025-2998
Phone 704-793-9593
Authorized official
John Kennedy Edmond
Executive Director
7047939593
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