Genesis Club House, INC.
Community/Behavioral Health in Worcester, MA. Organization (NPI-2).
NPI number1568871663
StatusActive
Last updated in NPPESJun 20, 2018
Details
- NPI
- 1568871663
- Entity type
- Organization (NPI-2)
- Legal business name
- Genesis Club House, INC.
- Organization subpart
- No
- Enumeration date
- Aug 4, 2014
- Last updated
- Jun 20, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Other names
- Genesis Club, INC. (Other Name)
Practice location
274 Lincoln StWorcester, MA 01605-2106
Phone 508-831-0100 · Fax 508-753-1286
Mailing address
274 Lincoln StWorcester, MA 01605-2106
Phone 508-831-0100 · Fax 508-753-1286
Authorized official
Kevin L Bradley
Executive Director
5088310100
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